两种抗凝方案下房间隔缺损封堵术后纤溶功能动态变化及意义

Effects of the fibrinolytic on two different anticoagulation protocols after transcatheter closure of atrial septal defects

目的探讨两种抗凝方案下,房间隔缺损(atrial septal defect,ASD)封堵术后纤溶功能的变化规律及其意义。方法 85例成功进行封堵术治疗的ASD患者随机分为延长低分子肝素(prolong low molecular weight heparin,pLWMH)组及低分子肝素(LWMH)组,采用酶联免疫吸附法测定封堵术前、术后即刻、术后第1、2、3、7天及术后第1、3个月血浆组织型纤维溶酶原激活物(tissue plasminogen activator,tPA)、D-D二聚体(D-Dimer)水平。结果封堵术前pLWMH组和LWMH组tPA、D-Dimer无明显差异;术后即刻两组tPA、D-Dimer均较术前明显增加并均达峰值(P<0.05);术后第1、2天两组tPA、D-Dimer均逐渐下降,仍较术前增加;术后第3天两组tPA、D-Dimer均接近术前水平,pLWMH组高于LWMH组,差异无统计学意义。结论无论低分子肝素组还是延长低分子肝素组,ASD封堵术后纤溶功能一过性激活,至术后3 d恢复术前水平。

Objective To investigate the effects of the fibrinolytil on the two different anticoagulation protocols after transcatheter closure of atrial septal defect（ASD） and the significance.Methods Eighty-five ASD patients who successfully underwent transcatheter closure of ASD were randomly divided into a low-molecular-weight heparin group（LMWH group） and a prolonged low-molecular-weight heparin group（pLMWH group）.ELISA was applied for detecting the levels of tissue plasminogen activator（tPA） and D-Dimer at different time points including before the operation,immediately after the operation,and 1,2,3,7,30 and 90 d after the operation.Results Before the operation,the levels of tPA and D-D dimer showed no significant difference between the pLMWH group and the LMWH group.The levels of tPA and D-D dimer of the two groups immediately after the operation increased significantly as compared with those before the operation,and reached their peak levels（P0.05）.The levels of tPA and D-D dimer declined slightly on 1 d and 2 d after operation（P0.05）,then decreased to be close to the baseline on 3 d,and returned to the baseline on 7,30 and 90 d.Conclusion The fibrinolytic system is transiently activated after transcatheter closure of ASD and returns to baseline on day 3 after operation in both the LMWH group and the pLMWH group.