胸腔术后胸腔大量渗血的原因分析

Analysis for the reasons of hemothorax after thoracic operation

目的：探讨开胸术后并发血胸的原因，为临床及时有效地使用止血药物提供理论依据。方法：观察了54例开胸手术病人，在术前、术中、术后24、72h血小板、凝血／抗凝血、纤溶／抗纤溶功能的动态变化。结果：术中血小板计数减少，聚集功能降低，术后恢复至正常水平；术中凝血功能正常，纤溶活性升高，术后抗凝血活性减弱，抗纤溶活性增强。结论：①围术期血小板和凝血因子的变化不是术后胸腔大量渗血发生的主要原因。②肺良性病变手术病人术后出血增多、易并发胸腔大量渗血的主要原因可能是肺切除时，肺组织释放大量的组织纤溶原激活物导致原发性纤溶亢进所造成的。术终测定优球蛋白溶解时间有助于判断，给予适量的抗纤溶药可有效防治。

objective: To explore the pathophysiological mechanism of postoperative intrathoracic hemorrhage to provide theoretical basis for clinical use of hemostats. Methods: The dynamic changes of blood platelet count (BPC), maximal aggregation rate (MAR ) and functions of coagulation/anticoagulation and fibrinolysis/antifibrinolysis were observed before and at the 24th and 72th h after operation in 54 patients undergoing throacotomy. Results: ① Although the platelets and coagulation factors were consumed and MAR decreased during operation, the changes of both number and aggregability of platelets recovered to normal after operation. ② Enhanced coagulation and decreased anticoagulation were shown postoperatively. ③ Fibrinolysis activity was activated during operation and inhibited after operation. Conclusion: ① The perioperative changes of platelets and coagulation factors are not the main cause of postoperative hemorrhage. ② The patients with benign lung disease has an increased bleeding volume after operation and will lead to hemothorax.The main cause is that the primary fibrinolysis is initiated by a considerable amount of tissue-type plasminogen activator released from damaged tissue during pulmonary resection.