摘要
目的:分析急性主动脉夹层患者基础凝血功能的特点及其在传统输血策略下围术期发生的变化,探讨该变化对于术后经验性输血策略的影响。方法:选择2012年9月—2013年1月在深低温停循环下接受全主动脉弓替换加象鼻支架手术的急性主动脉夹层患者20例,分别在麻醉诱导后(T1)、体外循环复温至36℃(T2)、鱼精蛋白中和后15 min(T3)、以及术后4 h(T4)4个时相点对每例患者抽取血样进行血栓弹力图检测,评价整体血凝块形成强度(MA)、凝血因子功能(R)、血小板功能(MAp)及功能性纤维蛋白原(MAf)水平,对各时相点的样本进行配对样本t检验。结果:急性夹层患者MAf基础水平(T1)较高,为(21.1±5.4)mm。各项指标在T2时相点时均显著低于T1时相点(P<0.05);在T3时相点仅有MAp基本恢复至术前水平(P>0.05),而其他指标仍显著低于T1;经过输血治疗后,T4时相点的MAp显著高于术前(P<0.05),MAf水平仍维持低水平并显著低于术前(P<0.05),而R、MA基本恢复术前状态(P>0.05)。结论:急性主动脉夹层患者基础凝血功能活化,术中纤维蛋白原损失较血小板损失更为严重,常规输血治疗可能导致纤维蛋白原补充不足而血小板补充过量。
Objective： The investigated study is to describe the changes of perioperative hemostatic function and assess the efficacy of traditional transfusion algorithm of those patients.Method： The study comprised twenty patients undergoing surgery for acute aortic dissection with deep hypothermic circulatory arrest cardiopulmonary bypass,from September 2012 to January 2013.The hemostatic functions of different coagulation components were measured by thromboelastogragh at four time points： anesthesia induction（T1）,rewarming to 36 ℃（T2）,after heparin neutralization（T3）,and four hours after operation（T4）.The whole hemostatic function,coagulatory factors funcations,platelet function,and functional fibrinogen content were measured by thromboelastograph and represented as MA,R,MAp,and MAf respectively.Results： The basic functional fibrinogen level is much high in those patients with acute aortic dissection： MAf1=（21.1±5.4）mm.All measurements,comparing with T1,were decrease significantly at T2.Platelet function had been gradually restored at T3（P0.05）,but other measurements were sustained at a low level.The overall coagulation function appeared to be restored with the transfusion therapy after protamine administration,except for fibrinogen（P0.05）.But the significantly high concentration of platelet（P0.05） remedied the dysfunction of fibrinogen.Conclusion： The whole hemostatic function seemed to be restored,but the fibrin formation is more impaired than platelet.Hemostasis with traditional transfusion management is disequilibrium and over-medication with platelet.
出处
《中国现代普通外科进展》
CAS
2013年第6期476-479,共4页
Chinese Journal of Current Advances in General Surgery
基金
国家自然科学基金(2011-81100178)
关键词
急性主动脉夹层
凝血功能
深低温停循环
纤维蛋白原
血小板
Hemostatic function·Fibrinogen
Platele·Deep hypothermia circulation arrest·Acute aortic dissection
