手术治疗前后血浆D-二聚体及纤维蛋白原水平的变化

Changes of plasma D-dimer and fibrinogen levels before and after surgical treatment

目的动态检测手术治疗患者术前后静脉血浆D-二聚体(D-D)及纤维蛋白原(FIB)水平,探讨其水平变化的临床意义。方法对322例手术治疗患者按手术类型进行分组,颅脑手术者55例(A组);心胸手术者38例(B组);骨科手术者96例(C组);腹部手术者79例(D组);妇产科手术者54例(E组),采集各组患者术前、术后24h内、术后3d、术后7d静脉血,用自动凝血仪检测血浆D-D及FIB水平。结果各组患者术后24h内、术后3d的D-D水平与术前比较明显增高,差异有统计学意义(P<0.01)。与术前比较,A、B、C组术后24h内、术后3d、术后7d的FIB水平降低,差异有统计学意义(P<0.05)。结论手术治疗后患者存在凝血及纤溶异常,特别是颅脑手术、心胸手术、骨科手术后应密切关注患者血浆D-D及FIB水平变化,对预防术后深静脉血栓形成等并发症及评估预后有重要的临床意义。

Objective To test dynamically the levels of D-dimer（D-D） and fibrinogen（FIB） in the treated with surgical proce- dures of patients and to explore its the clinical significance. Methods According to the operation types, 332 patients with treated with surgical procedures were divided into 5 groups. 55 cases from craniocerebral operation as group A;38 cases from thoracic oper- ation as group B;96 case from orthopedics operations as group C;79 cases from abdominal operation as group D;54 cases from ob- stetrics and gynecology operation as group E. Collected venous blood respectively before operation,within 24 hours after operation, after 3 days and 7 days after operation from the treated with surgical procedures of patients,then tested plasma D-D and FIB from the specimens by automatic blood coagulation analyzer. Results To compare with the specimens of all groups before operation,the levels of D-D were significantly higher within 24 hours after operation,and after 3 days after operation（P〈0.01）. To compare with the specimens of group A,B,C before operation,the levels of FIB were reduced within 24 hours after operation,after 3 days and 7 clays after operation（P〈0. 05）. Conclusion There are abnormal coagulation and fibrinolysis in patients after operation treatment, especially that after Craniocerehral, thoracic,or orthopedics operation. It＇s very important to pay attention to the changes of plasma D-D and FIB and to prevent the occurrence of deep venous thrombosis and postoperative complications.