止血药对腹部手术后凝血功能及深静脉血栓形成的影响

Impact of hemocoagulase on coagulatory function and deep venous thrombosis after abdominal surgery

目的探讨止血药对腹部手术后凝血功能及深静脉血栓形成的影响。方法2008年6月至2009年1月间福建医科大学附属协和医院收治的60例胃肠道肿瘤手术患者（胃癌20例，结肠癌40例），按随机数字表法分为使用与不使用止血药两组，每组30例。止血药组于手术当天、术后第1天应用巴曲亭2U／d。检测手术前、后D-二聚体（D—D）、组织纤溶酶原激活物（t-PA）、组织纤溶酶原激活抑制物（PAI．1）、凝血酶原时间（PT）、部分活化凝血酶时间（APTT）、凝血酶时间（TT）及血小板（PLT）的变化，并于术后5-7d行下肢深静脉彩超检查以明确有无血栓形成。结果与术前相比，两组患者术后D-D、t-PA、PAI-1均明显升高，PT、APTT延长，TT缩短，PLT减少，差异均有统计学意义（P〈0．05，P〈0．01）。与非止血药组相比，止血药组患者术后D．D、t—PA、PAI-1明显增高，TT缩短，差异有统计学意义（P〈0．05，P〈0．01）。止血药组和非止血药组分别有7例（23．3％）和3例（10．0％）术后出现左下肢深静脉血栓形成，差异无统计学意义（P〉0．05）。结论腹部手术后血液呈高凝状态．易导致深静脉血栓形成。术后使用止血药可加重高凝状态，增加深静脉血栓发生率；术后预防性止血药的应用应慎重。

Objective To investigate the impact of hemocoagulase on coagulatory function and deep venous thrombosis after abdominal surgery. Methods From June 2008 to January 2009, 60 cases （gastric cancer 20 cases, colonic cancer 40 cases） undergoing gastrointestinal surgery at the Union Hospital of Fujian Medical University were randomized to the hemocoagulase group and the control group （n=30 in each group）. Intravenous hemocoagulase at a daily dose of 2U was used on the same day and the next day postoperatively in the hemocoagulase group. D-dimer（D-D）, tissue plasminogen activator（t- PA）, plasminogen activator inhibitor-1 （PAI-1）, PT, APTT, TT, platelet count were measured before and after operation. Doppler ultrasound examination was carried out to exclude deep venous thrombosis on the 5th to 7th days after operation. Results Significant increased D-D, t-PA, PAI-1, prolonged PT, APTF, shortened TT and lower platelet count after surgery were noticed as compared to the baseline in both groups（P〈0.05, P〈0.01）. PT, APTT, D-D, t-PA, and PAI-1 significantly increased, and TT significantly shortened in the hemoeoagulase group as compared to the control group after surgery （P〈0.05, P〈0.01）. Deep venous thrombosis in the left lower limbs was noticed in 7 patients （23.3%） in the hemocoagulase group and 3 cases（10.0%） in the control group, however the difference was not statistically significant （P〉0.05）. Conclusions Hypercoagulable state usually appears after abdominal surgery and use of hemocoagnlase may aggravate hypercoagulability and increase the incidence of deep venous thrombosis in lower limbs after abdominal surgery. Preventative use of hemocoagulase must be administered with caution.