肺动脉与下腔静脉直接连接TCPC术后凝血功能变化

Analysis of long-term blood coagulation changes in modified extracardiac Fontan operation with direct total cavopulmonary connection

目的探讨肺动脉与下腔静脉直接连接TCPC术(DCPC)后凝血功能变化及意义。方法收集行DCPC术患者的术前、术后及随访时的临床资料及实验室检查结果,进行回顾性研究。结果共19例入组,男11例、女8例,中位手术年龄6.6(5.2~9.2)岁;与术前相比,患者出院时的凝血酶原时间、活化部分凝血活酶时间和血纤维蛋白原差异无统计学意义(P>0.05),而凝血国际标准比值和凝血酶原活动度较术前相比差异有统计学意义(P<0.05);随访时的凝血指标基本恢复正常,仅纤维蛋白原较术前稍高(P<0.05)。结论 DCPC术后的凝血功能变化不明显,非长期抗凝治疗的条件下无血栓等并发症发生,远期临床效果满意。

Objective Extracardiac Fontan operation with direct cavopulmonary connection has not been studied in detail. We investigated the long - term changes of blood coagulation in modified extracardiac Fontan operation with direct cavopuhnonary connection （DCPC）. Methods The clinical data of children with DCPC were collected in our insti- tution from July 2005 to December 2013, and analyzed retrospectively. Results Nineteen consecutive patients were en- rolled, including 11 males and 8 females, median aged of 6.6 （5.2 - 9. 2） years. There were significant differences between pre and postoperative data in INR and PTA, and significant increase in FIB during follow - up. There was no signif- icant difference in the other coagulation parameters. Conclusion After DCPC, changes of blood coagulation are not sig- nificant, and without anticoagulant therapy, the incidence of thrombosis and other complications is still very low. There- fore, long- term clinical outcomes are satisfactory.