血栓弹力图分析非体外循环冠状动脉旁路移植术围术期的凝血功能

目的采用了能反映凝血过程全貌的血栓弹力图(TEG)作为主要方法,结合血小板计数,分析非体外循环下冠状动脉旁路移植术围术期的凝血功能。方法选取在心外科行非体外循环下冠状动脉旁路移植术的连续135例患者,无手术死亡和中转体外循环下手术。于入手术室后、入ICU时和术后24 h 3个时间点分别采全血,做TEG和血小板计数,分析比较3个点的数值的变化。结果入ICU时和术后24 h的R时间、最大幅度和血小板计数较术前减少,LY30较术前增加,差异有统计学意义(P<0.01),入ICU时和术后24 h的这4项指标差异无统计学意义。有3例患者入ICU时和术后24 h均为LY30>8%,提示存在高纤溶状态。K时间和α角度各组的差异无统计学意义。结论非体外循环下状动脉旁路移植术后部分患者处于高凝状态,少数出现高纤溶状态;术后24 h凝血功能和血小板计数较术后无明显变化。

Objective To analyze the blood coagulation function in the off-pump coronary artery bypass grafting surgery patients with thromboelastography and blood platelet counting. Methods 135 consecutive patients with off-pump coronary artery bypass grafting surgery, no operative mortality and transfer to on-pump coronary artery bypass grafting. The patients＇ whole blood was drawn at 3 time points, including entering operating room, entering intensive care unit and 24 hours after surgery, to receive thrombelastography and blood platelet count. Compare 3 numerical changes using one way analysis of variance. Results When entering intensive care unit and after operation 24h, the reaction time, the maximum clot amplitude and the blood platelet count were decreased, lysis 30 was increased （P〈0.01）, comparing with entering operating room. The 4 parameteres of entering intensive care unit and after operation 24h were not significantly different. There was LY30 〉 8% in 3 patients entering intensive care unit and after operation 24h, which indicated a high fibrinolytic state. There was no significant difference in the K time and the a angle between the groups. Conclusion There were some patients with off-pump coronary artery bypass grafting surgery in hyper-coagulable state, handful patients in high fibrinolytic status; there was no obvious change in coagulation function and blood platelet counting when entering intensive care unit and 24 hours after surgery.