腹部外科危重患者凝血与纤溶变化的临床研究

Clinical study of coagulation and fibrinolysis in critical surgical patients

目的 探讨腹部外科危重患者凝血与纤溶动态变化特征。方法 监测腹部外科危重患者凝血与纤溶的一周变化 ,按是否有并发症分组分析。结果 就诊时各病例血抗凝血酶 Ⅲ (AT Ⅲ )、纤溶酶原(Plg)降低 ,血管性假血友病因子 (vWF)、α颗粒膜蛋白 1 4 0 (GMP 1 4 0 )升高 ,并发症组纤溶酶原激活物(t PA)降低、纤溶酶原激活物抑制剂 (PAI)升高 ,且vWF、GMP 1 4 0升高及Plg降低更显著 ;无并发症组AT Ⅲ和vWF逐渐恢复正常 ,并发症组仍持续异常 ;并发症组持续t PA降低及PAI增高 ,无并发症组却无变化 ;两组血小板 (PLT)、纤维蛋白原 (Fg)及α2 纤溶酶抑制剂 (α2 PI)均无变化。结论 腹部外科危重患者存在凝血与纤溶激活和血小板、内皮细胞受损 ;并发症组血小板和内皮细胞受损更严重 ,并伴有纤溶受抑 ,导致凝血与纤溶间失衡而产生高凝状态 ;无并发症组不存在纤溶受抑 。

Objectives To investigate the dynamical changes of coagulation and fibrinolysis in surgical critical patients.Methods Coagulation and fibrinolysis changes were monitored for one week after patients enrolled and results were compared according to presence and absence of complications.Results All patients' AT Ⅲ and Plg were decreased whereas their GMP 140 and vWF were increased on admission.The t PA of patients with complications was lower whereas their PAI was higher,and the increases of their GMP 140 and vWF were more significant than those of patients without complications. During the study periods,AT Ⅲ and vWF of patients without complications gradually recovered but patients with complications had persistently abnormal levels.t PA and PAI in patients with complications remained abnormal but unchaged in patients without complications.No changes in PLT,Fg and α 2 PI were found in any patients.Conclusion Critical patients had activation of coagulation and damages of platelet or endothelium.Patients with severe complications also had fibrinolysis inhibition and more severe platelet and endothelium damage,which resuled in an imbalance between coagulation and fibrinolysis.But patients without complications had no fibrinolysis inhibition and their endothelial damages recovered gradually. [