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骨科大手术后患者止凝血功能变化的监测 预览 被引量:3

Monitor of Blood Coagulative Function in Patients After Orthopedic Surgery
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摘要 目的 研究骨科大手术后患者止凝血功能的变化,筛选出患者血栓前状态的特异性监测指标及其最佳检测时机,为临床提供诊断治疗的依据.方法 纳入各类骨科大手术病例21例,健康对照21例.手术病例分别于术前1 d、术后3 d和7 d采血测定血浆凝血酶原时间(PT)、活化部分凝血酶原时间(aPTT)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白原(Fbg)、血管性血友病因子(vWF)、凝血酶-抗凝血酶复合物(TAT)、P-选择素(P-selection)、组织型纤溶酶原激活物(tPA)等指标,结果用重复性测量方差分析和单变量方差分析进行比较.结果 全部患者术后7 d康复顺利、无明显血栓并发症.(1)PT、aPTT手术前后7 d内差异不具有显著性(P>0.05),TT术后3 d与术前相比有所下降(P<0.05),但仍在参考范围以内(16-18 s).(2)D-D、Fbg浓度术后持续升高,术后7 d两项指标均明显高于术前(D-D 446.6±94.20 g/L vs 135.38±+87.25 g/L,P<0.O1;Fbg 5.17±1.50 g/L Vs 3.48±1.06 g/L,P<0.01).(3)vWF、TAT和P-选择素术后3 d较术前明显升高(vWF,127.08±7.20%vs 121.38 ±5.55%,P<0.01;P-选择素77.96±8.84 ng/ml Vs 73.88±5.16 ng/ml,P<0.01;TAT 16.84±6.30 ng,/ml vs 11.00±5.41 ng/ml,P<0.05).tPA术后3 d较术前下降明显(17.37±3.48 g/ml VS 21.39±6.65 g/ml,P<0.05).结论 常规凝血三项(PT、aPTT、TT)对于监测术后血栓前状态价值不大.D-D、Fbg术后非特异升高,对监测术后血栓形成价值有限.患者术后3 d vWF、p-选择素和TAT处于最高水平,tPA处于最低水平,提示患者术后3 d血栓前倾向严重,建议临床选择vWF、p-选择素、tPA和TAT等特异性指标监测凝血功能,必要时进行临床抗凝干预,防止术后血栓并发症. Objective To i nve st gat e coagul a t i on f unc t i on of pa t i ent s who have r ecei ved an ort hopedi cs oper a t i on,SO a s t o sel e ct t he pr opr i at e meas ur i ng t i me and speci f i c i ndi ca t or s f or moni t or i ng pret hr ombos i s af t er s ur ger y.Met hods 21 or t hopedi c oper at i on r e ci pi ent s wi t hout t hr ombos i s be for e and 21 normal cont r ol s wer e i nvol ve d.Al l of t he pa t i ent s wer e eva l uat ed re spect i vel y by measur i ng PT,aPTr ,33' ,Fbg,D- Di mer ,TAT,t PA, vWF,P-s el ect i on on t he day be for e t hei r oper a t i on,t he 3 day and 7 day pos t ope ra t i on.Whi l e t he normal c ont r oi s j ust need t o be meas ur ed one t ime.Res ul t s The pa t i e nt s af t er oper at i on ar e i n normal r ecove r i ng st at e dur i ng t he obs ervi ng 7 da ys ,wi t hout obvi ous t hr ombos i s compl i cat i on.The changes of t he l evel of aVIT and PT have no si gni fi ca nc e.The l evel of Tr on t he f or t h day af t er oper at i on were l ower t han be fore.whi l e al s o i n t he re fe re nc e r ange( 16~18 s ) .The concent ra t i on of Fbg and D- Di me r kept i ncr eas i ng af t er t he ope ra t i on,and t hei r l evel on t he s event h day af t er oper at i on exhi bi t s si gni f i cant di f f ere nc e compar i ng wi t h befor e operat i on(D· D446.6±94.20 g/L i n cont r as t t o 135.38 4- 87.25 s /L,P<0.01;Fbg 5.17±1.50 g/L i n cont r as t t o 3.48 4- 1.06 g/L,P<0.01) .TAT,vWF,P- s el ect ion wer e si gni f i cant l y hi ghe r on t he t hi r d day af t er oper at i on( vWF 127.08 4- 7.20%i n cont r as t t o 121.38 5.55%,P<0.01;P—se l e c t i on 7.96 8.84 ng/mJ i n cont r as t t o 73.88 5.16 ng/ml ,P<O.01;TAT 16.84 6.30 ng/nf ll i n cont r as t t o 11.00 5.41 ns /m1,P<O.05) .The l evel of t PA were si gn i f i can t l y l ower on t he t hi r d day af t er t he oper at i on t ha n bef or e(17.37 3.48 g/ml i n cont
作者 杨俊瑶 郑磊 王前 李强 武凯 熊石龙 YANG Jun-yao,ZHENG Lei,WANG Qian,LI Qian,WU Kai,XIONG Shi-long(Laboratory Medicine Centre,Nanfang Hospital,Southern Medical University,Guangzhou,510515,China)
出处 《血栓与止血学》 2010年第6期,共4页 Chinese Journal of Thrombosis and Hemostasis
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  • 1吴兆龙,廖履坦.肾病综合征及其高凝状态的治疗[J].中国实用内科杂志,1994,14(5):298-300. 被引量:17
  • 2段乃超,杨彦忠,马建刚.突发性聋患者血清AT-Ⅲ、PAI-1的检测及其临床意义[J].听力学及言语疾病杂志,2005,13(4):251-252. 被引量:3
  • 3[1]BOCK SC,HARRIS JF,BALAZS I,et al..Assignment of the human antithrombin Ⅲ structure gene to chromosome 1q 23-25[J].Cytogene Cell Genet,1985,39:67-74. 被引量:1
  • 4[2]EGEBERG O.Inherited antithrombin deficiency causing thrombo phieia[J].Thromb Diath Heomorrh,1965,13:516-530. 被引量:1
  • 5[3]PETERSON CB,BLACKBURN MN.Isolation and characterization of an antithrombin Ⅲ variant with reduced carbohydrate content a denhanced heparin bingding[J].J Biol Chem,1985,260:610-615. 被引量:1
  • 6[5]TOHGI H,KAGASHIMA M,TAMURA K,et al.Coagulation fibrinolysis abnormalities and chronic phases of cerbral thrombosis and em bolism[J].Stroke,1990,21:1663-1667. 被引量:1
  • 7[7]TOHGI H,KAWASHIMA M,TAMURA K,et al.Coagulation-fibrinolysis abnormoalities in acute and chronic phasea of cerebral thrombosis and emboilis[J].Stroker,1991,21:1663-1667. 被引量:1
  • 8Gram J, Sidelmann J, Jeapersen J. Does low protein concentration of tissue-type plasminogen activator predict a low risk of spontaneous deep vein thrombosis? Thromb Haemost, 1995, 74(2): 718-721. 被引量:1
  • 9Segui R, Estelles A, Mira Y, et al. PAI-1 promotor 4G/5G genptype as an additional risk factor for venous thrombosis in subjects with genetic thrombophilic defects. Br J Haematol, 2000, 111(1): 122-128. 被引量:1
  • 10Lang IM, Moser KM, Schleef RR. Elevated expression of urokinase-like plasminogen activator and plasminogen activator inhibitor type 1 during the vascular remodeling associated with pulmonary thromboembolism. Arterioscler Thromb Vasc Biol, 1998, 18(5):808-815. 被引量:1

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