术前血小板功能对冠脉搭桥患者出血的预测价值

Value of Preoperative Platelet Function on Predictive Bleeding in Patients with Coronary Artery Bypass

目的探讨术前血小板功能对冠脉搭桥患者出血的预测价值。方法选取96例行冠脉搭桥术患者作为研究对象,根据术后24h胸引流总量是否大于500m L分为正常术后出血组（58例）及严重术后出血组（38例）;术前,通过血小板计数（PLT）及全血凝固分析法（测定血凝四项）,对比两组患者术前PLT、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）及纤维蛋白原（FIB）的差异性,综合分析术前血小板功能与冠脉搭桥患者出血的关系。结果严重术后出血组患者术前,PLT为170.36±38.4×109/L、PT为16.8±5.2 s、APTT为40.7±13.7 s、中位TT为18s、FIB为4.21±1.32 g/L;正常术后出血组患者术前,PLT为196.32±50.5×109/L、PT为14.2±3.2 s、APTT为35.1±8.2 s、中位TT为13s、FIB为4.82±0.74 g/L;严重术后出血组患者术前的PLT及FIB显著低于正常术后出血组（P〈0.05）,PT、APTT及中位TT显著长于正常术后出血组（P〈0.05）;两组患者的MA值和血小板抑制率（INHADP、INHAA）差异显著（P〈0.05）;术前PLT对冠脉搭桥患者术后出血具有预测价值（OR=2.11,95%CI：1.80~2.36,P〈0.01）,术前FIB对冠脉搭桥患者术后出血具有一定的预测价值（OR=1.90,95%CI：1.70~2.04,P〈0.05）。结论冠脉搭桥患者术后出血与术前血小板功能具有相关性,通过测定PLT及FIB评价术前血小板功能,对冠脉搭桥患者出血具有预测价值。

Objective To evaluate the predictive value of preoperative platelet function in patients with coronary artery bypass grafting bleeding. Methods 96 patients undergoing coronary artery bypass routine as research subjects, depending on total bleeding volume within 24h postoperative chest drainage were divided into normal postoperative hemorrhage group （58 cases）and severe postoperative hemorrhage group （38 cases）. The preoperative platelet count（ PLT）and whole blood coagulation in patients were detected. The prothrombin time （PT）, activated partial thromboplastin time（AFFF）, thrombin time（TF）and fibrinogen（FIB） in both groups were analyzed. Results The PLT and FIB before the operation in severe bleeding patients group were significantly lower than that of normal bleeding group （ P 〈 0. 05 ） , while the PT, AI：qT and TT were significantly longer than that of normal bleeding group （ P 〈 0.05 ）. The maximal amplitude and inhibition of platelet had significantly different between two groups （P 〈 0.05 ）. The preoperative coronary PLT and FIB had bleeding predictive value for patients with coronary artery bypass （ P 〈 0. 01 ）. Conclusion There is some correlation between preoperative platelet function and bleeding in patients with coronary artery bypass. The preoperative platelet function could have predictive value in patients with coronary artery bypass bleeding. grafting