凝血及纤溶指标检测对治疗手术后出血的价值  

The evaluation of thrombotest on patients suffering from perioperative hemorrhage

作　　者：王博[1] 祝学光[1] 李军[1] 周静[1] 安友仲[1] 

机构地区：[1]北京大学人民医院普外科实验室,100044

出　　处：《中华普通外科杂志》2003年第6期367-369,共3页Chinese Journal of General Surgery

摘　　要：目的探讨术中及术后 2 4h内失血量大于 10 0 0ml患者适宜的干预措施。方法筛选 2 0 0 0年 1月至 2 0 0 2年 1月间SICU所收治的外科择期手术 ,术前肝功能及血常规正常 ,术中出血与术后 2 4h手术部位引流血液大于 10 0 0ml的患者共 89例。进入SICU后记录心率、血压、体温 ,检测血色素 (Hb)、血小板 (PLT)、血球压积 (HCT)、凝血酶原时间 (PT)、部分凝血活酶时间 (APTT)、纤维蛋白原 (FIB)及纤维蛋白降解产物 (FDP)、D二聚体 (D dimer) ,记录围手术期的血液及血制品用量。结果随着出血增加 ,PT由 (11 4± 0 6 )s延长至 (16 0± 0 6 )s(P <0 0 1) ,APTT由 (32 5±2 2 )s延长至 (4 7 8± 1 2 )s(P <0 0 1) ,FIB由 (5 19± 6 6 )mg/dl减少至 (2 5 2± 2 8)mg/dl(P <0 0 1) ,FDP和D dimer也有升高趋势。结论对于重度出血患者 ,及时有针对性的补充缺失的血液成分是成功治疗各种术后出血的关键。Objective This study was to explore the appropriate therapy for perioperative hemorrhage(intraoperative and 24 h postoperative blood loss>1000 ml).Methods From 2000 to 2002,a total of 89 critically ill surgical patients were enrolled whose preoperative liver function and blood analysis were normal. The patients′ heart rate?blood pressure?body temperature?hemoglobin(Hb)?platelet count(PLT)?hematocrit(HCT)?prothrombin time(PT)?activated partial thrombo-plastin time(APTT)?fibrinogen concentration(FIB)?fibrinogen degrade product(FDP)?D-dimer immediately after enrollment into the study were determined. Results As the blood loss increased PT prolonged from(11.4±0.6) s to (16.0±0.6) s ( P<0.01) and APTT prolonged from (32.5±2.2) s to (47.8±1.2) s( P<0.01),FIB decreased from(519±66) mg/dl to (252±28) mg/dl( P<0.01),FDP and D-dimer also increased. Conclusion For massive perioperative bleeding timely and appropriate supplement of the blood component exhausted is a key for the treatment of perioperative coagulopathy caused by bleeding.

关 键 词：凝血 纤溶指标 检测 治疗 手术后出血 

分 类 号：R619[医药卫生—外科学]