常温体外循环围术期凝血及纤溶机制变化的临床研究

Clinical study of hemoststic and fibinolytic changes in patients during and followine open heart op- eration under normothermic cardiopulmonary bypass (CPB)

对20例常温体外循环心内直视手术病人围术期的血小板计数、血小板功能、纤维蛋白原、抗凝血酶Ⅲ、α_2抗纤溶酶、纤溶酶原、D-二聚体和血栓弹力图等进行了连续监测和临床分析.结果表明,体外循环下术中及术后当天凝血功能下降,纤溶系统活性显著增高,机体处于低凝状态;术后第一天起机体逐步进入高凝状态并同时伴有纤溶.因此,术后应慎用纤维蛋白原和血小板等促凝物质,以免发生血栓形成和加重纤溶.

The platelet count and its function, and the levels of fibrinogen, antithrombin Ⅲ (AI-Ⅱ) and alpha 2-antiplasmin, plasminogen, D-dimer and were determined and analysed in 20 patients undergoing open-heart surgery with normthermic CPB. The results showed that the patients were in hypocoagulation and hyperfibrinolysis state during CPB and the day of operation, then entered into hypercoagulation and fibrinolysis state after the 1st postoperative day. The authors suggest that the use of large dose of fibrinogen and platelet should be avoided, so as to preveation thrombin and hyperfibrinolysis, especially after the coronary artery bypass grafting and valvular replacement.