紫绀型先天性心脏病围术期血液流变学及凝血功能改变研究

PERIOPERATIVE HEMORRHEOLOGIC AND HEMOSTATIC CHANGES IN CYANOTIC CONGENITAL HEART DISEASE

研究２０例紫绀型先天性心脏病患者（平均年龄１２．１０±７．６７岁）手术前后血液流变学及凝血功能变化，发现这类患者术前血液处于高凝状态，主要为红细胞的变形能力显著低于正常水平（Ｐ＜０．０２）。凝血功能异常主要表现为术前血小板第３因子、因子ＶＩＩＩ相关抗原、因子ＩＸ、因子ＸＩ、因子ＸＩＩ已有异常（Ｐ＜０．０５）；而术后因子Ｖ异常（Ｐ＜０．０５）、血小板聚集功能显著降低（Ｐ＜０．０５）以及血小板第３因子进一步损害。这些因素共同构成紫绀型先天性心脏病术后易出血因素，其中血小板功能改变起主导作用。术后第１天出血量在该组患者为４６８．７５±３２１．７０ｍｌ，而非紫绀型先天性心脏病患者仅２９７．５０±２０５．１８ｍｌ（Ｐ＜０．０２）。同时发现出血量与术前红细胞压积呈正相关（ｒ＝０．６４，Ｐ＜０．０２）。文中还对改变术前高凝状态、保护血小板功能及防止术后出血进行了讨论。

Twenty cases of cyanotic congenital heart disease were studied to reveal the perioperative hemorrheologic as well as hemostatic changes.The results showed that not only preoperative deformability of RBC was very poor,but also factors PF-3,vWf,ⅠX,XⅠ,and XⅡ were below normal.During CPB,the platelet factor Ⅲ was further damaged,and could not recover three days after surgery.After CPB,the ability of platelet aggregation was reduced to about 50% of its preoperative level(p<0.05).All these were considered as causes of abnormal bleeding in patients with cyanotic congenital heart disease following CPB,among which platelet dysfunction was the most important. The average bloor loss in the first postoperative day was 463.75±321.70 ml in these patients,while in non-cyanotic congenital cases only 297.50±205.18 ml(p<0.02).As a positive correlation was preseent between bloor drained from wound postoperatively and the preoperative hematocrit,the preoperative hematocrit could be used as a predictor for assessing the severity of postoperative bleeding.Detailed discussion on the hypercoagulative state before operation and protection of platelet function during CPB were mentioned.