冠状动脉介入治疗前后凝血功能变化分析

Analysis of changes in coagulation function before and after coronary intervention

目的探讨冠心病患者经皮冠状动脉介入治疗(PCI)前后凝血功能的变化,为临床治疗提供依据和指导。方法以2013年9月至2014年8月78例接受PCI的冠心病患者为研究对象,检测其手术服药前及术后4、24h的凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)与纤维蛋白原(Fg)、抗凝血酶(AT)水平的变化,并进行比较分析。结果 78例冠心病患者单支病变56例,双支病变19例、三支病变3例,病变支数共115支;病变支分别植入支架101、35、8个,共植入144个支架。PCI术前TT、APTT分别为(14.1±0.4)、(38.4±1.5)s,术后4h分别为(64.1±5.8)、(73.5±15.7)s,较术前时间延长,差异均有统计学意义(P<0.05);术后24h所测TT、APTT、PT、Fg及AT与术前比较差异均无统计学意义(P>0.05),均恢复正常。结论可在PCI术后4、24h常规监测患者TT及APTT以反应抗凝情况,AT水平正常的患者在PCI术后4h已恢复正常,无需常规监测。

Objective To investigate changes of coagulation function before and after percutaneous coronary intervention（PCI） in patients with coronary heart disease ,so as to provide evidence and guidance for clinical treatment .Methods A total of 78 patients with coronary heart disease who received PCI from September 2013 to August 2014 were regarded as subjects .The thrombin time （TT） ,thrombin original time （PT） ,activated partial thromboplastin time （APTT） and levels of fibrinogen （Fg） and antithrombin （AT） were detected before surgery and 4 ,14 h after surgery ,and conducted analysis and comparison .Results In the 78 cases of pa‐tients with coronary heart disease ,56 cases with single vessel disease ,19 cases with double vessel disease ,3 cases with three le‐sions ,and the total lesion count was 115 ;diseased vessels were implanted 101 ,35 and 8 stents respectively ,and a total of 144 stents were implanted .The TT and APTT before PCI was （14 .1 ± 0 .4） and （38 .4 ± 1 .5） s respectively ,and was （64 .1 ± 5 .8） and （73 .5 ± 15 .7） s respectively 4 h after surgery ,the differences were statistically significant （P〈0 .05）;while there were no statis‐tically significant differences of TT ,APTT ,PT ,and levels of Fg 24 h after surgery compared with those before PCI（P〉0 .05） ,and these indicators were back to normal .Conclusion Routine monitoring TT and APTT 4 ,24 h after PCI could reflect coagulation function ,while routine monitoring may not be necessary for patients whose levels of AT are back to normal 4 h after surgery .