肺癌食管癌开胸手术患者术中凝血功能改变及其临床意义

Changes and clinical significance of coagulation function of patients with lung cancer or esophagus cancer in thoracotomy

目的应用血栓弹性描记仪观察肺癌、食管癌开胸手术患者围术期凝血功能的改变。方法择期行手术治疗的肺癌患者10例,中段或上段食管癌患者10例,观察麻醉前5min(T0)、手术开始后1h(T1)、手术结束后30min(T2)血栓弹性描记仪参数中反应时间(reaction time,R)、凝血形成时间(clotting time,K)、α角(αangle)和最大振幅(maximumamplitude,MA)等指标的变化。10例健康志愿者为对照组。结果与正常对照组相比,肺癌患者和食管癌患者术前R值缩短,相差显著(P<0.05)。肺癌患者T1时间点R值、K值延长,α角和MA减小,与T0比较相差显著(P<0.05),术后T2时间点仍然有MA减小,与T0比较相差显著(P<0.05);肺癌患者与食管癌患者相比在T1时间点R、K延长,α角和MA减小,相差显著(P<0.05),T2时间点α角和MA减小,两组比较相差显著(P<0.05);纤溶指数LY30值在T1、T2时间点与T0比较以及同时间点与食管组比较相差显著(P<0.05)。食管癌患者术中、术后TEG变化与T0比较相差均无显著性(P>0.05),T2时间点CI(coagulation index)值与T0比较相差显著(P<0.05);T1时间点与肺癌组比较,R、K有缩短。结论两组恶性肿瘤患者术前可能存在高凝状态,肺癌组患者术中、术后凝血功能逐渐趋于低凝状态,而食管癌组患者术中、术后继续有高凝的趋势。

Objective To study the coagulation of patients with lung cancer or esophagus cancer in thoracotomy during perioperative period. Methods Variables [ reaction time （R）, clotting time （K）, α angle, maximum amplitude （MA）] detected by thrombelastography were measured in 10 cases of lung cancer and 10 cases of upper or median esophagus cancer before anesthesia （ T0 ）, at the end of 1 h after operation beginning （ T1 ） and 30 min after operation （T2）. The control group consisted of 10 healthy volunteers. Results In lung cancer group and esophagus cancer group, R was shorter than control group （ P 〈 0.05 ）. R and K were longer, α angle and MA were smaller at T1 than at TO （ P 〈 0.05 ） , and MA was smaller at T2 than at TO in lung cancer group. R and K were longer, α angle and MA were smaller at T1 , and α angle and MA were smaller at T2 in lung cancer group than in esophagus group （ P 〈 0.05 ）. LY30 （ fibrinolysis index） at T1 and T2 was longer in lung cancer group than in esophagus cancer group （ P 〈 0.05 ）. CI （ coagulation index） was longer at T2 in esophagus cancer group than in lung cancer group （ P 〈 0.05 ）. Conclusion Patients with lung cancer or esophagus cancer have possibility of hypercoagulability before operation. decreased during and after operation, and hypercoagulability of esophagus after operation.