非体外循环冠状动脉旁路移植术患者手术前后凝血功能的变化

Coagulation Function Changes in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

目的探讨非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)患者手术前后凝血功能的变化。方法 2009年12月～2011年3月,选择76例OPCAB,于手术当天清晨及术毕进入恢复室时取静脉血进行血栓弹力图(thromboelastography,TEG)分析,术后血样处理选用含肝素酶的测定杯消除残余肝素对结果的干扰,观察TEG中的R时间,K时间,α角,MA,A30,CL30,LY30等指标的变化情况。结果手术前后K时间和α角差异无显著性(P>0.05),与术前相比,术后R时间、MA、A30和CL30均减小,而LY30增加,差异有显著性(P<0.05)。术后均未出现死亡,无脑卒中和心肌梗死等并发症发生,无二次开胸探查,术后出院顺利。结论 OPCAB患者术后呈高凝状态,且纤溶过程相对亢进。

Objective To analyze coagulation function changes in patients undergoing off-pump coronary artery bypass grafting （OPCAB） through thromboelastography （TEG）. Methods From December 2009 to March 2011, 76 patients with OPCAB were selected in our hospital. The first blood sample was taken in the morning before operation, and the second was taken when the patient came back to ICU. We used heparinase-modified TEG assays to eliminate residual heparin. R time, K time, angle α, MA, A30, CL30, LY30 changes were observed in TEG. Results No significant differences were found in K time and angle α before vs. after the surgery （P 〉 0.05）. Compared with preoperative results, post-operative R time, MA, A30 and CL30 all decresed while LY 30 increased with significant difference （P 〈 0.05）. No death, no complications like stroke and myocardial infarction occurred. No re-exploration for bleeding was required in all cases. Conclusion There is a hypercoagulable state with relative hyperfibrinolysis in patients after OPCAB.