慢性肝病患者肝叶切除术凝血纤溶活性检测的意义

Perioperative Determination on Function of Blood Coagulation and Activity of Fibrinolysis in Hepatectomy Patients Accompanied with Chronic Hepatic Disease

目的探讨慢性肝病患者行肝叶切除术围手术期凝血纤溶活性的变化及其意义。方法将2003年1月至2004年2月重庆医科大学附属第二医院肝胆外科收治的35例伴乙肝肝硬变的手术患者根据疾病和手术的不同分为肝叶切除术组(n=18)和非肝叶切除术组(n=17),并分别于术前、术毕和术后24h采集外周静脉血,测定其凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)和D二聚体(D D)含量。结果非肝叶切除组患者的PT、APTT和TT在手术前后不同时相间比较差异无统计学意义(P>0.05);肝叶切除组PT水平术前明显高于术毕和术后,并明显高于非肝叶切除组(P<0.01),APTT术后则明显高于术前和术毕,也高于非肝叶切除组(P<0.01),而TT在组内不同时相间及与非肝叶切除组相应时间比较差异无统计学意义(P>0.05)。2组患者Fbg和D D水平术后均较术前和术毕明显升高(P<0.05),但2组间比较差异无统计学意义(P>0.05)。结论慢性肝病患者实施肝叶切除术时,血液处于低凝和继发性纤溶亢进状态,提示有潜在出血的危险,应加强围手术期处理。

Objective To investigate the changes and significances of the activity of blood coagulation and fibrinolysis in hepatectomy patients accompanied with chronic hepatic disease. Methods Thirty-five patients who were accompanied with cirrhosis undertook surgery in the second affiliated hospital of Chongqing Medicall University from year 2003 to 2004 were divided into two groups： the first group of 18 cases received hepatectomy and the sec ond group received non-hepatectomy surgical treatment. The （prothrombin time PT）, （activated partial thrombopl-atin time APTT）, （thrombin time TT）, and the content of （Fibrinogen Fbg） and （D-dimer D-D） in the blood drawn from peripheral veins were quantitatively measured by a fully-automatic chromogenic and immunological assay machine （ACL-Futura 9000,USA） at the phases of before operation, right after operation and 24-hour after operation, respectively. Results APTT in hepatectomy group increased significantly （P〈0.01） and were much higher than the non-hepatectomy group at corresponding phases （P〈0.01）. PT in hepatectomy group increased even more significantly compared with that of preoperation and right after the operation （P＇〈0.01）. The differences of TT at varying phases in hepatectomy group were of no significance （P〉0.05）. There was also no significant difference of PT, APTT, and TT in non-hepatectomy group at varying phases. Conclusion The function of blood coagulation is relatively poor and the secondary activity of fibrinolysis is over-activated in hepatectomy patients accompanied with chronic hepatic disease, which indicates a high risk of hemorrhage.