抗凝血酶对StanfordB型主动脉夹层覆膜支架置入术中凝血功能的影响

Effects of antithrombin on coagulation and fibrinolysis function in endovascular stent implantation for Stanford type B aortic dissection

目的探讨抗凝血酶对StanfordB型主动脉夹层覆膜支架置人术患者凝血功能的影响及临床意义。方法40例行覆膜支架置入术的StanfordB型主动脉夹层患者随机分为抗凝血酶组和对照组。抗凝血酶组于肝素化前和后24h静注3000U抗凝血酶，对照组为空白对照。丽组分别于术前和术后即刻、1d和2d检测血小板计数（PLC）、血浆抗凝血酶Ⅲ浓度（AT-Ⅲ）、凝血酶原时间国际化标准比值（PT—INR）、部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、凝血酶时间（TT）和D-二聚体（DD）。结果AT-Ⅲ浓度术前两组均低于正常值，而术后抗凝血酶组AT-Ⅲ浓度显著升高，对照组无明显改变，两组间比较，差异有统计学意义（P〈0．05）。两组术前FIB和DD均高于正常值，而两组术后FIB、DD、PLC和Am均逐渐升高，但抗凝血酶组显著低于对照组（P〈0．05），TF仅在抗凝血酶组升高。结论StanfordB型主动脉夹层覆膜支架置人术患者凝血与纤溶功能持续激活，机体处于高凝状态，而抗凝血酶能减轻机体的这种状态，对预防术中术后不良反应的发生有积极作用。

Objective To explore the clinical significance and effectiveness of antithrombin in blood coagulation and fibrinolysis function in endovascular stem implantation for Stanford type B aortic dis- section. Methods Forty patients with Stanford type B aortic dissection underwent endovascular stent im- plantation and were divided into the antithrombin group and the control group. In the antithrombin group, 3000 U antithrombin was infused over 30 min before heparin administration and 24 h later. The control group served as a blank control. Platelet counts （ PLC）, serum concentrations of antithrombin m （ AT m ）, prothrombin time international normalized ratio（ PT-INR ）, activated partial thromboplastin time （APTr）, fibrinogen （ FIB ）, thrombintime （TY） and D-dimer（DD） were measured before the surgery, at the end of the surgery,and 1 and 2 days after surgery. Results The AT ~I concentration before the surgery was lower than the normal concentration in both groups, h was low continually in the control group after surgery, whereas it was increased in the antithrombin group after surgery, with a significant difference between the groups. In both groups, FIB and DD were increased preoperatively compared with the normal value. PLC, APTT, FIB and DD were increased postoperatively in both groups, but the levels of these indicators in the antithrombin group were significantly lower than those in the control group （ P 〈 0.05 ）. TT was increased only in the antithrombin group postoperatively. Conclusion In patients undergoing endovascular stent implantation for Stanford type B aortic dissection, both coagulation and fibrinolysis are continually activated, resuhing in a hypercoagulation state. Antithrombin could decrease the hypercoagulation, which may have positive effects on preventing adverse events.