糖尿病患者脊柱手术前后凝血状态的变化

Changes in blood coagulation in patients with diabetes mellitus before and after the spinal surgery

目的探讨糖尿病患者在脊柱手术前后凝血状态的变化。方法从2011年8月至2012年8月在脊柱外科随机选取60例拟行腰椎内固定手术的患者,分成两组。其中40例有糖尿病史合并症者为实验组,20例无糖尿病合并症者为对照组。两组分别于术前、术后第1、3、7天清晨空腹采集肘前静脉血液标本,检测血栓弹力描记图(TEG)[R时间、K时间、α角(Angle)、血栓最大幅度(MA)、凝血综合指数(CI)]、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(Fib)以及血小板计数(PLT)等指标的变化。结果术前实验组患者与对照组相比,K缩短,α角、MA增大、CI增大,Fib升高,差异有统计学意义(P<0.05)。术后实验组与对照组相比,第1～7天K缩短,α角、MA、CI增大,Fib升高,差异有统计学意义(P<0.05)。在术后第1～7天,实验组R、K缩短,α角、MA增大,Fib升高,差异有统计学意义(P<0.05)。对照组K缩短,α角、MA、CI增大,Fib升高;CI在术后第7天比第3天降低,差异有统计学意义(P<0.05)。两组PLT、PT和APTT在手术前后以及组间相比差异无统计学意义。结论糖尿病患者存在血液的高凝状态,脊柱手术可进一步加重血液的高凝程度。TEG是检测高凝状态的敏感指标,Fib与TEG的参数有明显的相关性。动态监测糖尿病患者脊柱手术前后TEG和Fib的变化有利于对血栓危险性的判断。

Objective To investigate the changes in blood coagulation in patients with diabetes mellitus before and after the spinal surgery. Methods 60 patients who underwent internal fixation of the lumbar spine were randomly selected in the Department of Spinal Surgery from August 2011 to August 2012. According to the presence of diabetes complications, all of them were divided into 2 groups： the experimental group （n=40） and the control group （n=20）. In the antecubital vein blood specimens from the patients on an empty stomach in the morning in each group, thromboelastography （TEG） variables, including R-time, K-time, alpha angle （α-angle）, maximum amplitude （MA） and coagulation index （CI）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, platelet count （PLT） and so on were measured preoperatively and on the 1st day, 3rd day and 7th day after the surgery. Results Preoperatively in the experimental group, the K-time was decreased, and the α-angle, MA, CI and Fib were increased, when compared with that of the control group. The differences between the 2 groups were statistically significant （P〈0.05）. From the 1st day to the 7th day after the surgery, the K-time was decreased, and the α-angle, MA, CI and Fib were increased in the experimental group, when compared with that of the control group. The differences between the 2 groups were statistically significant （P〈0.05）. From the 1st day to the 7th day after the surgery, the R-time and K-time were decreased, and the α-angle, MA and Fib were increased in the experimental group. The differences among them were statistically significant （P〈0.05）. The K-time was decreased, and the α-angle, MA, CI and Fib were increased in the control group. CI was decreased on the 7th day after the surgery, when compared with that of the 3rd day, and the differences between them were statistically significant （P〈0.05）. In both groups, PLT, PT and APTT did not change significantly preoperatively and postoperatively. Conlusions Patients with diabetes mellitus have hypercoagulable states, which can be further aggravated due to the spinal surgery. TEG is a sensitive indicator for hypercoagulability, and there is an obvious correlation between the Fib and TEG parameters. It is better to estimate the risk of blood clots when the changes in TEG and Fib parameters are dynamically monitored before and after the spinal surgery in patients with diabetes mellitus.