术中保温对先天性心脏病患者术后凝血及纤溶系统的影响  

Effects of intraoperative insulation on postoperative coagulation and fibrinolytic system in patients undergoing congenital heart disease surgery

作　　者：王奇 浮志坤[2] WANG Qi;FU Zhikun(Department of Cardiology,the First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China;Department of Cardiac Surgery,the Seventh People′s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院心脏外科,南阳473000 [2]郑州市第七人民医院心脏外科,郑州450000

出　　处：《华夏医学》2024年第2期162-167,共6页Acta Medicinae Sinica

基　　金：河南省医学科技攻关计划项目(2018020861)。

摘　　要：目的探讨术中保温措施对先天性心脏病(简称“先心病”)患儿术后凝血、纤溶系统的影响。方法选取126例先心病患儿为研究对象,随机分为对照组和干预组,每组63例。两组均接受介入封堵术治疗,在此基础上,对照组采用常规治疗,干预组术中采取积极保温措施辅助治疗。比较两组的凝血功能、凝血-纤溶系统动态平衡相关参数和手术应激反应情况。结果治疗后,干预组活化部分凝血酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)均低于对照组,差异具有统计学意义(P<0.05);干预组血小板计数(PLT)、纤维蛋白原(FIB)均高于对照组,D-二聚体(D-D)低于对照组(P<0.05);干预组凝固启动时间(CST)、完全纤溶时间(WFT)、平衡时间(BLT)均低于对照组;干预组去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)均低于对照组(P<0.05)。结论术中保温能有效改善先心病患儿的凝血功能及纤溶系统功能,对维持凝血-纤溶系统动态平衡,降低手术应激反应均有积极意义。Objective To observe the effect of intraoperative insulation measures on postoperative coagulation and fibrinolysis systems in patients with congenital heart disease(referred to as"congenital heart disease").Methods 126 children with congenital heart disease were selected as the research subjects and randomly divided into two groups,with 63 cases in each group.Both groups were received interventional closure surgery,while the control group were received routine treatment,while in the intervention group,active insulation measures were taken to assist in treatment.The coagulation function,fibrinolytic system,dynamic balance parameters of coagulation fibrinolytic system,and surgical stress were compared between the two groups of children.Results Under different treatment regimens,the activated partial thrombin time(APTT),thrombin time(TT),and prothrombin time(PT)of the intervention group were lower than those of the control group,with a statistically significant difference(P<0.05).The platelet count(PLT)and fibrinogen(FIB)of the intervention group were higher than those of the control group,while the D-dimer(D-D)was lower than that of the control group(P<0.05).The coagulation start time(CST),complete fibrinolysis time(WFT),and equilibrium time(BLT)of the intervention group were all lower than those of the control group.The levels of norepinephrine(NE),cortisol(Cor),and angiotensinⅡ(AngⅡ)in the intervention group were lower than those in the control group(P<0.05).Conclusion Intraoperative insulation can effectively improve the coagulation function and fibrinolytic system function of children with congenital heart disease,maintain the dynamic balance of the coagulation fibrinolytic system.

关 键 词：先天性心脏病 术中保温 凝血功能 纤溶系统 手术应激 

分 类 号：R654[医药卫生—外科学]