颅内动脉瘤栓塞术后凝血功能变化的临床研究

The impact of intracranial aneurysm embolism surgery on coagulation function

目的:探讨颅内动脉瘤栓塞术后患者凝血功能的变化及其临床意义。方法:选择出血性脑血管疾病行全脑血管造影及颅内动脉瘤栓塞术患者63例作为观察组,因其他原因仅行全脑血管造影患者87例作为对照组。分别检测两组手术前及术后第1、6天血小板计数(plt)、纤维蛋白原(Fg)、D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)等6项指标水平。结果:(1)观察组术后第1天Fg、plt、D-D水平显著升高,与术前及术后第6天比较,有显著性差异(P<0.05);术后第1天PT、APTT、TT水平与术前及术后第6天比较,无显著性差异(P>0.05);术后第6天6项指标水平与术前比较无显著性差异(P>0.05)。(2)观察组与对照组术前6项指标比较,差异均无统计学意义(P>0.05);观察组术后第1天Fg、Plt、D-D水平明显高于对照组,具有显著性差异(P<0.05);而PT、APTT、TT水平与对照组比较,无显著性差异(P>0.05)。结论:颅内动脉瘤栓塞术后第一天凝血系统被激活,Fg、plt、D-D水平显著升高,提示患者处于高凝状态,并有继发性纤溶亢进,且这三项指标优于常规凝血常规检查,可应用于脑血管病介入治疗术后并发症的防治。

Objective Investigate the coagulation function variation and the clinical significance of patients after the intracranial aneurysm embolism surgery.Methods Select 63 samples of patients who suffered the hemorrhagic cerebrovascular disease and received the intracranial aneurysm embolism surgery as observation group,and compare them with 87 samples of patients who received the cerebral angiography for other reasons(control group).Record the platelet count(plt),fibrinogen(Fg),D-dimer(D-D),prothrombin time(PT),activated partial thromboplastin time(APTT) and thrombin time(TT) measured before and after 1 and 6 days of the surgery.Results The plt,Fg and D-D of the observation group measured after 1 day of the surgery were significantly higher than those measured before the surgery(P<0.05).The difference of the plt,Fg and D-D levels between the observation group and the control group measured 1 day after the surgery has a statistical significance(P<0.05),while the difference measured 6 days after the surgery does not have a statistical significance(P>0.05).The differences of PT,APTT and TT levels before and after the surgery do not have statistical significances(P>0.05).Conclusion The coagulation system is activated 1 day after the intracranial aneurysm embolism surgery,and the plt,Fg,D-D levels elevate,indicating that the patient is in hypercoagulable state and has a secondary fibrinolytic hyperthyroidism.These measurement indicators are superior to routine cruor imaging inspections for the detection of the cruor-fibrinolysis obstacles of the patients received the intracranial aneurysm embolism surgery.