维生素K_1对小儿心内直视手术围术期凝血机制的影响

Effect of Vitamin K_1 on Perioperative Blood Coagulation Factors During Open Heart Surgery in Children

目的 小儿心内直视手术中应用维生素 K1 (Vitamin K1 ,Vit K1 ) ,观察其对凝血因子的作用。 方法 30例心脏手术患者分为 3组 ,A组 :动脉导管未闭患者 ;B组 :使用 Vit K1 治疗 ;C组 :未使用 Vit K1 治疗。每组各 10例。分别检测 A组术前、术后 ,B组、C组术前 2 4小时、麻醉后开胸前、鱼精蛋白中和后 10分钟、术毕、术后 6小时、1天、3天和 5天的血浆凝血酶原时间 (PT)、激活部分凝血活酶时间 (APTT)、凝血酶时间 (TT)、X因子活性、纤维蛋白原含量和红细胞压积。 结果 鱼精蛋白中和后 10分钟血浆凝血酶原时间、激活部分凝血活酶时间、凝血酶时间最长 ,X因子活性、纤维蛋白原含量最低。与 C组相比 ,B组术后 2 4小时内血浆凝血酶原时间明显缩短 ,X因子活性明显升高。 结论 术前应用 Vit K1 可明显提高患者术后早期凝血因子水平 ,有利于减少术后出血的发生。

Objective\ To assess the effect of vitamin K 1 (Vit K 1) on blood coagulation factors during open heart operation in children.\ Methods\ Thirty patients undergoing cardiac operation were assigned to three groups:group A: patent ductus arteriosus patients( n=10) ; group B:patients with cardiopulmonary bypass(CPB) plus Vit K 1 therapy( n=10) ; group C: patients with CPB, with no Vit K 1 administered ( n=10) . Blood sample were obtained for the measurement of prothrombin time, activated partial thromboplastin time, thrombin time, factor X activity, plasma fibrinogen concentration and haematocrit.\ Results\ Prothrombin time, activated partial thromboplastin time, thrombin time are the longest, factor X activity and plasma fibrinogen concentration is the lowest on 10 minutes after injected protamine. Prothrombin time of group B was significantly shortening and factor X activity of it was increased than group C in 24 hours postoperation.\ Conclusion\ Activity of coagulation factors can be increased and maintained at a higher level by Vit K 1 therapy. It is avail of reducing blood loss after cardiac surgery.