脊柱创伤患者围术期凝血功能及血小板的变化规律分析

Analysis of the Changes of Blood Coagulation Function and Platelet during Perioperative Period in Patients with Spinal Trauma

目的观察脊柱创伤患者围术期凝血功能及血小板的变化规律。方法选取2013年08月至2014年09月我院收治的脊柱骨折(ASAⅡ~Ⅲ级)患者55例,对患者手术前后的凝血时间(a PTT、PT、TT)、血小板计数(BPC)、Fbg、D二聚体((D-D)进行测定,比较其变化规律。结果 (1)55例患者手术时间2.9 h^4.5 h,平均手术用时(3.61±0.83)h;81.8%(49/55)的患者出血量大于自身出血量(>30%);平均尿量(846.47±163.21)ml;输入浓缩红细胞量平均(381.44±199.49);(2)T1期时,患者Hct、Hb、BPC、Fbg水平较手术前出现下降,Hct、Hb水平在T1期后浮动无明显差异(P>0.05);TT与a PTT表达时间均较手术前明显延长,在T3期表达时间最长(P<0.01);Fbg在T3期水平最低(P<0.05);D-D手术前平均值为465.78μg/L,手术后D-D呈上升趋势(P<0.01)。结论脊柱创伤患者围术期凝血功能及血小板处于抑制状态,D-D在围术期受创伤、手术影响表现为逐渐上升趋势,术后血液系统呈高凝状态。

Objective To investigate the changes of blood coagulation and platelet during perioperative period in patients with spinal trauma. Methods 55 cases of patients with spinal fractures（ ASA Ⅱ-Ⅲ） were selected from August 2013 to September 2014 in our hospital. Measured the blood coagulation,platelet count and D-dimer（ D-D） of the patients before and after operation. And Compared the changes of blood coagulation and platelet function in patients with spinal trauma during perioperative period. Results（ 1） The operation time of the 55 patients was 2. 9 h to 4. 5 h,the average operation time was（ 3. 61 ＋ 0. 83） h; the bleeding volume of 81. 8%（ 49/55） of patients was more than the amount of bleeding（ 30%）; the average urine volume was（ 846. 47 ＋ 163. 21） ml; input average of CRBC was（ 381. 44 ＋199. 49）;（ 2） During T1 period,the levels of Hct,Hb,BPC Fbg were lower than those before operation,and there was no significant difference in the changes of Hct and Hb levels after T1 period（ P〉0. 05）; The expression time of TT and a PTT was significantly longer than those before operation,and the longest time of expression was in T3 phase（ P〈0. 01）; Fbg level was lowest in the T3 phase（ P〈0. 05）; The average value of D-D was 465. 78 g/L before surgery,after surgery D-D increased,and it was statistically significant comparing with that before surgery（ P〈0. 01）. Conclusion The blood coagulation function and platelet during perioperative period in patients with spinal trauma are in a state of inhibition. D-D shows a gradual upward trend due to trauma or surgery,postoperative blood system was a high coagulation state.