摘要
目的研究腹部大手术患者凝血功能的变化,并探讨其临床意义。方法测定2000年9月至2005年3月我院35例腹部大手术者手术前后血浆凝血酶原时间(PT),部分凝血活酶时间(APTT),纤维蛋白原(FIB),血小板计数(PLT)水平的变化,以30例正常人为对照。结果腹部大手术组与对照组相比,术前FIB水平较高,两者差异有显著性(P=0.008),术后PLT水平明显降低,PT则显著延长,差异有显著性(P值分别为0.000及0.015)。腹部大手术者术前术后比较,PT明显延长,FIB和PLT水平则降低,差异均有显著性(P值分别为0.019,0.013及0.002)。伴发肝病的腹部大手术者术后FIB和PLT水平明显低于非肝病患者(P值分别为0.000及0.024)。术后死亡患者PLT水平低于存活患者,PLT水平低于50.0×109/L的患者死亡率为100%。结论腹部大手术者术前常呈高凝状态,术后则可呈现高凝,相对纤溶抑制和低凝;术中大出血或伴有肝病易诱发术后出血;术后PLT减少是预测患者死亡的独立危险因素。
Objective To explore the changes of blood coagulation system and clinical significances in critically ill patients with a major abdominal operation. Methods Prothrombin time （PT）, partially activated thromboplastin time （APTT）,platelet （PLT）and fibrinogen （FIB） of 35 critically ill Results patients were detected pre and post operation and compared with 30 healthy individuals. （1）There was a higher FIB level in preoperative critically ill patients compared with the group of normal control （NC）, while after operation there were a lower PLT and a longer PT in those ill patients,and all the differences are statistical significance.（2）The longer PT,lower FIB and PLT in the postoperative patients had statistical differences co mpared with the preoperative patients. （3） Patients with liver disease had a lower FIB and PLT after operation compared with those without liver disease. （4）Patients of postoperative death had a lower PLT count than those survivor and the mortality was 100% in patients with a less than 50.0×10^9/L platelet count. Conclusion In critically ill patients, there could be a hypercoagulative state before operation, while after operation the patients may be hypercoagulation, relative inhibition of fibirinolysis and hypocoagulation. Serious intraoperative bleeding and accompanying liver disease might lead to a postoperative bleeding. Postoperative thrombocytopenia is an independent dangerous factor for predecting the poatient＇s death.
出处
《岭南现代临床外科》
2006年第1期21-23,36,共4页
Lingnan Modern Clinics in Surgery
关键词
外科
手术
凝血功能加强医疗
Surgical operation
Blood coagulation function
Intensive care
