体外循环心脏手术病人围术期血凝-纤溶的动态变化

Coagulation-fibrinolysis dynamics during open heart surgery with cardiopulmonary bypass

目的:观察体外循环(CPB)心脏手术患者血凝-纤溶系统动态平衡的变化。方法:20例体外循环手术患者,应用血凝-纤溶动态图检测仪,分别于CPB前、CPB后、术后24小时、48小时及168小时采血样检测血凝-纤溶系统动态平衡的变化。结果:CPB后的凝固启动时间(CST)、凝固峰值时间(MCT)、完全纤溶时间(WFT)及平衡时间(BLT)均明显长于CPB前(P<0.01),术后24小时逐渐恢复。而最大凝固程度(MCE)从CPB后持续显著增高到术后168小时(P<0.1)。血凝-纤溶动态图图形在CPB后变成低平尾长的曲线,术后24小时形态基本恢复正常。结论:CPB心脏手术患者的血凝-纤溶系统处于动态平衡状态。CPB后为最低平衡状态,术后24小时至术后168小时逐渐恢复。

Objective: To observe the balance of modified coagulation and fibrinolysis in patients undergoing open heart surgery with cardiopulmonary bypass (CBP). Method: The balance of modified coagulation-fibrinolysis in 20 cases were measured by coagulation-fibrinolysis dynamicography instrument (FD-Ⅲ) at the pre-CPB, post-CPB, 24, 48 and 168 hours postoperatively. Result: At the post-CPB, coagulation starting time(CST), maximum coagulation time (MCT), whole time of fibrinolysis reaction (WFT) and balance time (BLT) were significantly more than at pre-CPB (P<0.01) and retuned to normal after postoperative 24 hours. Post-CPB maximum extent of coagulation (MCE) was significantly increased from post-CPB to post-operation 168th hour (P<0.01). The graph of modified coagulation-fibrinolysis became lower and longer at post-CPB and it returned to normal at post-operation 24th hour. Conclusion: The balance of modified eoagulation-fibrinolysis is remained in the patients undergoing open-heart surgery with CPB. At post-CPB the balance of coagulation-fibrinolysis is lower, and it was close to normal from postoperative 24th hour to 168th hour.