心脏直视术后凝血机制的变化及其临床意义  

The blood coagulation mechanism changes and the clinical significances after cardiac operation under direct vision

作　　者：辛英才[1] 毕克毅[1] 苗青[1] 董惠芳[2] 杨晓刚[1] 严志昌[2] 王勤[1] 于武年[1] 

机构地区：[1]内蒙古医学院第三附属医院心胸外科,内蒙古包头014010 [2]内蒙古医学院第三附属医院心胸检验科,内蒙古包头014010

出　　处：《中国冶金工业医学杂志》2002年第6期323-326,共4页Chinese Medical Journal of Metallurgical industry

摘　　要：目的 :本文对心脏手术围术期凝血机制相关的凝血指标进行连续检测和动态观察 ,以期发现体外循环术后凝血机制变化的特征和发展规律。方法 :自 1996年 7月随机对 30例体外循环心脏手术病人从术前至术后 72小时 7个时段的 18项凝血指标 ,采用酶联免疫吸附法进行连续检测。结果 :tPA水平术后早期显著增高 ,约为术前的 2倍 (P <0 0 1) ,术后 2 4小时后恢复术前水平。PAI水平则显著降低 ,仅为术前水平的4 5% (P <0 0 5) ,而且术后至 72小时一直处于低水平。PAI的变化与术后引流量呈显著负相关性 (P <0 0 0 1)。D -Dimer术后呈进行性增高 (P<0 0 1)。外源性凝血因子术后 1小时FⅡ ,FⅤ和FⅩ显著低于术前 (P <0 0 5) ,同时伴D -Dimer进行性增高。内源性凝血因子与FIB于术后 1小时恢复术前水平。术后 2 4小时后 ,所有凝血因子均增高 ,以内源性因子更为显著 ,同时伴TT和APTT的缩短。结论 :( 1)心脏术后并发症的原因纤溶系统紊乱可能起主要作用 ,PAI的降低可引起纤溶亢进 ,从而导致术后早期引流量增多 ;PAI增高则有发生血栓形成或栓塞的危险 ,建议围术期监测PAI,有助于预测并发症。 ( 2 )CPB术后凝血机制紊乱 ,术后 12小时内血液低凝状态 ,术后 2 4小时后变为高凝状态 ,有发生血栓形成倾向 。Objective:The clotting indexes related to the blood coagulation mechanism were detected continually and observed dynamically during the cardiosurgery,so as to find out the feature and the regularity of development of blood coagulation mechanism changes after cardiopulmonary bypass(CPB).Methods:Thirty cases with CPB cardiac surgery patients from July in 1996 were studied randomly,by which 18 variant clotting indexes were detected consecutively at 7 time-intervals from preoperation to postoperation 72 hours with enzyme linked immunosorbent assay(ELISA).Results:The tPA level elevated significantly in early postoperation,it was about twice of the preoperative value(P<0 01),and recovered to the preoperative level after postoperation 24 hours.But the PAI level reduced significantly,it was only 45% of the preoperative level(P<0 05),and kept low level from postoperation to postoperation 72 hours.The PAIs changes showed significant negative correlation with the blood loss of postoperation(P<0 001).The D-Dimer level elevated progressively after operation(P<0 01).The extrinsic coagulation factors such as FⅡ\,FⅤ and FⅩ after operation 1 hour were still significantly lower than the level of preoperation (P<0 05),with the D-Dimer progressive elevation.The intrinsic coagulation factors and FIB recovered to the level of preoperation after operation 1 hour.After postoperation 24 hours,all the coagulation factors elevated,and the intrinsic coagulation factors elevated significantly,with TT and APTT shortening.Conclusions:(1)It showed that the fibrinolysis system disturbance might play an important role in causing complication after cardiosurgery,the low PAI might cause fibrinolysis overactivity,and then it might induce the blood loss to increase in early postoperation;The high PAI might cause the risk of thrombosis or embolism,so the PAI was suggested to detect during the operation in order to prevent complication.(2)The blood coagulation mechanism disturbance after CPB,the blood was in hypocoagulable state during 12

关 键 词：心脏直视术 凝血机制 临床意义 手术后 凝血因子 纤溶酶原 

分 类 号：R654.2[医药卫生—外科学]