冠状动脉介入治疗中血小板计数、抗凝血酶-Ⅲ对激活凝固时间的影响

Relationship of platelet,antithrombin-Ⅲ and active coagulation time in patients with peractaneous coronary intervention

目的研究冠状动脉介入术(PCI)患者的血小计数(PLT)、抗凝血酶-Ⅲ(AT-Ⅲ)活性与激活凝固时间(ACT)的关系。方法选择60例PCI患者,根据术前PLT水平将患者分成两组,高PLT组(PLT≥240×109/L)22例,低PLT组(PLT<240×109/L)38例。分别于PCI术前、术中应用肝素10000 U后5分钟、术后4小时鞘管内抽动脉血,测定AT-Ⅲ活性、ACT值,分析PLT、AT-Ⅲ活性对ACT的影响。结果①高PLT组术前、术中及术后AT-Ⅲ活性较低PLT组低,分别为(77.5±8.6)%vs(99.7±9.8)%,P<0.05;(68.0±8.8)%vs(89.2±8.0)%,P<0.05和(73.2±8.1)%vs(81.6±5.0)%,P<0.05。高PLT组术前、术中及术后ACT较低PLT组低,分别为(125.6±17.4)svs(161.0±11.1)s,P<0.05;(469.1±51.6)svs(568.1±51.6)s,P<0.05和(189.1±16.6)svs(204.8±19.4)s,P<0.05。②应用肝素后5分钟ACT与术前AT-Ⅲ活性正相关,r=0.9012,P<0.05,与术前PLT呈负相关,r=-0.4735,P<0.05。结论PLT偏高、AT-Ⅲ活性差的PCI患者肝素的抗凝效果差,出现肝素抵抗的可能性大。

Objective To observe the relationship of platelet （PLT）, antithrombin-Ⅲ （AT-Ⅲ） activity and active coagulation time （ACT） in the patients with peractaneous coronary intervention（PCI）. Methods Sixty patients undergoing selective PCI were involved in the research. They were divided into two groups according to their preoperative PLT ：higher PLT group （ n = 22） with PLT≥240 × 10^9/L,lower PLT group （ n = 38） with PLT 〈240 × 10^9/L. The activities of AT-Ⅲ and ACT were measured immediately after PCI before heparnization,after 5 minutes loading 10 000 U heparin injection,and 4 hours postoperatively. The relationship of PLT,AT-Ⅲ activity with ACT was analyzed. Results （1）The activity of AT-Ⅲ before PCI,5 minutes loading heparin 10 000 U and 4 hours after operation was lower in higher PLT group than that in lower PLT group, respectively （77.5 ± 8.6）% vs （99.7 ± 9.8）%, P 〈 0.05; （68.0±8.8） % vs （89.2±8.0） %, P 〈0.05 and （73.2±8.1） % vs （81.6±5.0） %, P 〈0.05. ACT before PCI ,after 5 minutes loading 10 000 U heparin injection or 4 hours after operation was lower in higher PLT group than that in lower PLT group,respectively （125.6±17.4） s vs （161.0±11.1） s, P 〈0.05; （469.1±51.6） s vs （568.1±51.6） s, P 〈0.05 and （189.1±16.6） s vs （204.8±19.4） s, P 〈0.05. （2）The value of ACT had a positive relationship with the activity of antithrombin Ⅲ（ r =0. 9012, P 〈0.05） and it had a negative relationship with the counts of PLT （ r = -0. 4735, P 〈0.05）. Conclusion The patients with higher PLT and decreased activity of AT-Ⅲ may have worse heparin anticoagulating effects and have more risk of suffering from heparin tolerance with PCI.