脾脏破裂患者手术前后外周血心肌酶谱、凝血功能及血小板参数的变化及意义  

Changes and significance of peripheral blood myocardial enzymes,coagulation function and platelet parameters in patients with spleen rupture before and after operation

作　　者：雷俊 周正武[1] 马建中[1] LEI Jun;ZHOU Zhengwu;MA Jianzhong(Department of Emergency Surgery,Lu’an People’s Hospital,Lu'a n,Anhui,237005,China)

机构地区：[1]六安市人民医院急诊外科,安徽六安237005

出　　处：《临床急诊杂志》2021年第2期103-110,共8页Journal of Clinical Emergency

摘　　要：目的:探讨脾脏破裂患者手术前后心肌酶谱、凝血及血小板参数的变化及意义。方法:收集2017年1月—2020年3月期间我院收治的69例创伤性脾破裂患者作为脾破裂组,按1∶1∶1比例收集同期收治的69例非脾破裂腹部外伤患者作为对照1组,同期69例健康体检者作为对照2组;脾破裂组、对照1组均于术前(T0)、术后6 h(T1)、术后1 d(T2)、术后3 d(T3)、术后1周(T4)、术后4周(T5)采集外周血,对照2组于体检当日采血,测定心肌酶谱、凝血功能及血小板参数,分析上述各项指标与脾脏破裂分级的关系。结果:脾破裂组T0~T4点肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)高于对照1组(P<0.05),脾破裂组、对照1组T0点CK、CK-MB、LDH均高于对照2组(P<0.05);脾破裂组、对照1组不同时间点纤维蛋白原(Fib)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、凝血因子Ⅶ活性(FⅦ:C)、凝血因子Ⅻ活性(FⅫ:C)比较存在组间、时间、交互效应(P<0.05);脾破裂组T0点Fib、FⅦ:C、FⅫ:C低于对照组2组,PT、TT较对照2组延长,APTT较对照2组缩短(P<0.05);与T0点比较,T2~T5点脾破裂组血小板计数(PLT)上升(P<0.05),对照1组T2~T5点PLT高于T0点(P<0.05),脾破裂组、对照1组T0点PLT低于对照2组(P<0.05);脾破裂组PLT升高至出现异常时间短于对照1组,PLT异常持续时间长于对照组1组(P<0.05),PLT峰值较对照组1组高,达峰值时间较对照1组短(P<0.05);脾脏破裂分级Ⅲ~Ⅳ级组T0~T5点CK、CK-MB、LDH高于Ⅰ~Ⅱ级组(P<0.05),T1~T5点Fib、FⅦ:C、FⅫ:C低于Ⅰ~Ⅱ级组(P<0.05),PT、TT长于Ⅰ~Ⅱ级组(P<0.05),APTT短于Ⅰ~Ⅱ级组(P<0.05),T3~T5点PLT高于Ⅰ~Ⅱ级组(P<0.05)。结论:脾破裂早期存在明显心肌损伤,脾切除术后血液处于不同程度高凝状态,PLT增多,且与脾破裂程度有关。脾切除术后需重视心肌酶谱、凝血及PLT监测,并针对性给予心肌保护及抗凝、抗血小板聚集药�Objective:To investigate the changes and significance of myocardial enzymes,coagulation and platelet parameters in patients with spleen rupture before and after operation.Methods:This retrospective study enrolled 69 patients with traumatic spleen rupture(spleen rupture group),69 patients with non-spleen rupture abdominal trauma(control group 1)and 69 normal healthy individuals(control group 2)from January 2017 to March 2020.Peripheral blood samples of the spleen rupture group and the control group were respectively collected before operation(T0),6 h after operation(T1),1 d after operation(T2),3 d after operation(T3),1 week after operation(T4),and 4 weeks after operation(T5),while those of the control group 2 were collected during physical examination.Changes in myocardial enzymes,coagulation function and platelet parameter were determined,and their relationship with spleen rupture classification was analyzed.Results:From T0 to T4,creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and lactate dehydrogenase(LDH)in the spleen rupture group were higher than those in the control group 1(P<0.05).At T0,CK,CK-MB and LDH in the spleen rupture group and the control group 1 were higher than those in the control group 2(P<0.05).The comparison of fibrinogen(Fib),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),coagulation factorⅦactivity(FⅦ:C)and coagulation factorⅫactivity(FⅫ:C)in the spleen rupture group and the control group 1 showed inter-group,time and interaction effects(P<0.05).At T0,Fib,FⅦ:C and FⅫ:C in the spleen rupture group were lower than those in the control group 2,PT and TT were longer than those in the control group 2,and APTT was shorter than that in the control group 2(P<0.05).Compared with T0,platelet count(PLT)in the spleen rupture group and the control group 1 was higher from T2 to T5(P<0.05).At T0,PLT in the spleen rupture group and the control group 1 was lower than that in the control group 2(P<0.05).Compared with the control group 1,the spleen rupture gr

关 键 词：腹部外伤 脾脏破裂 心肌酶谱 凝血 血小板 血栓 

分 类 号：R657.6[医药卫生—外科学]