不同分度脾脏破裂行全脾切除术后患者凝血功能变化临床研究  

Changes of coagulation function in patients with different grades of spleen rupture after total splenectomy

作　　者：闵琦 刘剑 MIN Qi;LIU Jian(Department of Emergency Medicine,Shangluo Central Hospital,Shangluo 726099,China)

机构地区：[1]商洛市中心医院急诊医学科,陕西商洛726099

出　　处：《陕西医学杂志》2022年第7期828-830,834,共4页Shaanxi Medical Journal

基　　金：陕西省社会发展科技攻关项目(XJYFY-2015-86)。

摘　　要：目的:探究不同分度脾脏破裂行全皮切除术后患者凝血功能的变化趋势,为临床手术治疗提供参考价值。方法:选取进行全脾切除术治疗的60例无原发性疾病的创伤性脾脏破裂患者作为观察组研究对象,并根据脾脏损伤分级分为A组(Ⅰ-Ⅱ级)、B组(Ⅲ-Ⅳ级),随机选取同时期进行体检的60例健康人作为对照组。①记录并比较观察组与对照组患者体内D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)以及血小板计数(PLT)表达水平;②比较不同分度脾脏损伤患者围术期PT、APTT、FIB、TT以及PLT水平变化情况。结果:①与对照组相比,观察组患者术后D-D、FIB以及PLT表达水平均有明显升高,PT、TT均有明显延长,APTT有明显缩短,且组间比较差异具有统计学意义(均P<0.05);②对于不同分度脾脏损伤患者而言,围术期Ⅲ-Ⅳ级脾脏破裂患者体内FIB、PLT、PT、TT水平明显高于Ⅰ-Ⅱ级脾脏破裂患者,APTT明显低于Ⅰ-Ⅱ级脾脏破裂患者,且组间比较差异具有统计学意义(均P<0.05)。结论:创伤性脾脏破裂患者经全脾切除术后,机体处于血液高凝状态,各项凝血指标均发生明显改变,同时不同分度脾脏破裂患者术后凝血功能受到的影响不同,脾脏破裂程度越严重,对围术期凝血功能的影响越严重。Objective:To explore the change trend of coagulation function in patients with different grades of spleen rupture after total splenectomy,and to provide reference for clinical surgical treatment.Methods:A total of 60 traumatic splenic rupture patients without primary disease who underwent total splenectomy were selected as the research subjects,and were divided into group A(grade Ⅰ-Ⅱ)and group B(grade Ⅲ-Ⅳ)according to the grade of spleen injury.A total of 60 healthy people who underwent physical examination at the same time were selected as control group.The levels of D-dimer(D-D),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT)and platelet(PLT)were compared between the observation group and the control group.The perioperative levels of PT,APTT,FIB,TT and PLT were compared in patients with different grades of spleen injury with.Results:Compared with the control group,the levels of D-D,FIB and PLT in the observation group after operation were significantly increased,the PT and TT were significantly prolonged,and the APTT was significantly shortened(all P<0.05).For patients with different grades of spleen injury,the levels of FIB,PLT,PT and TT in patients with perioperative grade Ⅲ-Ⅳ spleen rupture were significantly higher than those in patients with grade Ⅰ-Ⅱ spleen rupture,and APTT was significantly lower than that in patients with grade Ⅰ-Ⅱ spleen rupture(all P<0.05).Conclusion:After total splenectomy,patients with traumatic spleen rupture are in a hypercoagulable state of blood,and all coagulation indexes are significantly changed.Meanwhile,different degrees of spleen rupture have different effects on postoperative coagulation function.The more severe the spleen rupture,the more serious the impact on perioperative coagulation function.

关 键 词：不同分度 脾脏破裂 全脾切除术 凝血功能 变化趋势 

分 类 号：R657.6[医药卫生—外科学]