法洛四联症患者围术期凝血因子与抗凝因子活性变化及其临床意义

Plasma Pro- and Anti-coagulation Factor Activity of Patients in the Perioperative Period of Surgical Correction for Tetralogy of Fallot and Its Clinical Significance

目的探讨法洛四联症患者围术期凝血因子和抗凝因子活性变化及其临床意义。方法将2010年1月至2013年4月南方医科大学附属南方医院经法洛四联症矫治术治疗的47例法洛四联症患者纳入研究，其中男35例，女12例；年龄1．20～26．00（8．00±6．48）岁；体重8．70～46．00（18．20±21．50）蝇。所有患者均在手术前及手术后第4、7、10d常规检测血浆凝血因子Ⅱ、Ⅶ、Ⅷ、Ⅸ、X以及抗凝血酶Ⅲ和蛋白C活性，同时测定血浆凝血酶原时间（prothrombintime，PT）和活化部分凝血酶时间（activatedpartialthromboplastintime，APTT）。结果法洛四联症患者术后早期凝血因子Ⅱ（术后第4d：102．66％＋20．61％VS．69．27％±16．51％）、Ⅶ、Ⅷ、Ⅸ、X（术后第4d：125．43％±39．97％VS．64．80％±11．46％）活性均较术前水平显著升高，于术后第4～7d达到峰值，在术后第10d仍显著高于术前。PT、APTT值在术后早期均显著下降，在术后第10d仍显著低于术前水平；血浆抗凝血酶Ⅲ及蛋白C活性在术后早期均呈上升趋势，至术后第10d均恢复至术前水平。结论法洛四联症患者术前存在凝血功能障碍，术后凝血因子活性增强及凝血功能恢复可能与缺氧改善有关；术后早期的凝血因子活性增强有利于正常止血，而术后晚期则存在凝血／抗凝平衡向着凝血功能增强方向倾斜，有发生血栓形成的风险，可进行适当的抗凝／抗血小板治疗。

Objective To investigate plasma pro-and anti-coagulation factor activity of patients in the perioperative period of surgical correction for tetralogy of Fallot （TOF） and its clinical significance. Methods From January 2010 to April 2013, 47 patients undergoing surgical correction for TOF in Southern Hospital of Southern Medical University were enrolled in this study. There were 35 male and 12 female patients with their age of 1.20-26.00 （ 8.00± 6.48） years and body weight of 8.70-46.00 （ 18.20± 21.50） kg. Preoperatively and on the 4th, 7th and 10th postoperative day, activity of plasma coagulation factor II, V, V$, IX and X, and antithrombin III （AT BI ） and protein C levels of all the patients were routinely measured, as well as prothrombin time （PT） and activated partial thromboplastin time （APTT）. Results Activity of plasma coagulation factor 11 （on the 4th postoperative day： 102.66%4-20.61% vs. 69.27%±-16.51%）, VII, IX and X （on the 4th postoperative day： 125.43% 4- 39.97% vs. 64.80%_ 11.46%） of TOF patients in the early postoperative period was significantly higher than preoperative level, reached the summit between the 4th and 7th postoperative day, and was still significantly higher than preoperative level on the 10th postoperative day. PT and APTT levels significantly decreased in the early postoperative period, and were still significantly lower than preoperative levels on the 10th postoperative day.Plasma AT 11I and protein C levels were significantly increased in the early postoperative period but returned to preoperative levels on the 10th postoperative day. Conelusions Preoperatively, haemostatic function of TOF patients is usually abnormal. Postoperative increased plasma procoagulant factor activity and recovered haemostatic function may be related to the correction of hypoxic state. In the early postoperative period, increased plasma procoagulant factor activity is helpful for haemostatic function. In the late postoperative period, an imbalance of pro- vs anti-coagulation factors in plasma occurs towards stronger haemostatic function, which may increase the risk of thrombosis and render anticoagulant and antiplatelet therapy necessary.