患者止凝血功能对支气管镜诊疗导致出血的影响

Effect of anticoagulant function on bleeding complications during fiberoptic bronchoscopy for diagnosis and treatment

目的探讨血栓与止血检验对支气管镜诊疗过程中可能发生大出血、血栓形成和窒息的预测价值。方法回顾性分析广州市胸科医院2016年1月至2019年12月36785例次的支气管镜诊疗操作中50例出血超过30 ml患者的临床资料,比较分析有无窒息症状、出血量大小(>100 ml为大出血)和有无血凝块患者间D2聚体(D2)、凝血酶原时间(PT)、凝血酶原比值(PTR)、凝血酶原国际比值(PTINR)、纤维蛋白原(Fbg)、部分活化凝血活酶时间(APTT)、凝血酶时间(TT)的差异。结果14例窒息发生患者中的D2、PTINR异常发生率和Fbg水平显著高于36例未发生窒息患者(P值分别为0.033、0.006和0.006);31例发生小出血患者和19例发生大出血患者比较,大出血患者Fbg异常发生率显著高于小出血患者(χ^2=4.402,P=0.036);36例未发生血栓患者与14例发生血栓患者对照,血栓者PTINR、Fbg异常发生率远高于非血栓者(P值分别为0.006和0.041),Fbg水平亦然(t=3.446,P=0.001);以止凝血功能异常作为暴露因素,窒息患者比非窒息患者、大出血患者比小出血患者和有血栓患者比无血栓患者间的21个比值比(OR)在0.355~14.400,其中16个OR值大于2.500。结论对止凝血功能检查异常者,在行支气管镜检查和镜下治疗时,应谨防大出血、血栓形成和窒息等并发症的发生。

Objective To investigate the predictive value of thrombosis and hemostasis tests on the possible occurrence of bleeding,thrombosis,and asphyxia complications during fiberoptic bronchoscopy for diagnosis and treatment.Methods The clinical data of fifty cases with bleeding over 30 ml during fiberoptic bronchoscopy,which were screened from 36785 patients accepting fiberoptic bronchoscopy from January 2016 to December 2019 in Guangzhou Chest Hospital,were analyzed retrospectively.These cases were divided into asphyxia group and non-asphyxia group,or hematorrhea group(more than 100 ml of bleeding)and small hemorrhage group,or thrombosis group and non-thrombosis group.As for analysis of abnormal incidence and amount level,included thrombosis and hemostasis tests were as follows:D2 polymer(D2),prothrombin time(PT),prothrombin time ratio(PTR),prothrombin time international normalized ratio(PTINR),fibrinogen(Fbg),partial activated thromboplastin time(APTT),thrombin time(TT).Results Abnormal incidences of D2,PTINR and level of Fbg of 14 cases with asphyxia were significantly higher those of 36 cases without asphyxia(P values were 0.033,0.006,and 0.006 respectively).Compared with 31 cases with small hemorrhage,19 cases with hematorrhea had a significantly higher incidence of abnormal Fbg(χ^2=4.402,P=0.036).Abnormal incidences of PTINR and Fbg of 14 cases with thrombosis were significantly higher than those of 36 cases without thrombosis(P values were 0.006 and 0.041 respectively);moreover,the level of Fbg was the same(t=3.446,P=0.001).Taking the abnormal coagulation function as the exposure factor,the values of 21 odds ratios(OR)of asphyxia vs.nonasphyxia,hematorrhea vs.small hemorrhage,and thrombosis vs.non-thrombosis were from 0.355 to 14.400,of which 16 OR were above 2.500.Conclusion It is essential that the patients with abnormal coagulation function are paid more attention to prevent complication such as hematorrhea,thrombosis,and asphyxia during fiberoptic bronchoscopy.