摘要
目的 观察体外循环 (CPB)围术期凝血酶 -抗凝血酶 (TAT)的改变以及采用肝素涂层管道与注射肝素两组病例TAT改变的差异。方法 2 3例CPB心脏机械瓣膜置换者 ,分为应用肝素组(UCG) 15例 ,肝素涂层组 (HCG) 8例 ,分别在术前 5min、肝素化后 5min、CPB转流 6 0min、鱼精蛋白中和后30min、6 0min、术后 4、12h采血。用酶联免疫试验检测TAT ,凝血一期法检测血浆凝血因子X活性(FX∶C)。结果 2 3例病人围术期TAT均较正常人显著增高 ,在CPB期间及鱼精蛋白中和升高尤为明显 ,FX∶C在术中有明显减低。两组TAT、FX∶C改变趋势大致相同 ,但HCG组改变程度较UCG组轻。结论 病人CPB手术前存在某种程度高凝状态 ,术中有明显凝血过度激活和凝血因子消耗 ,鱼精蛋白中和后TAT高达 6 0 0 μg L是值得高度重视的现象。
Objective: To investigate the variation of thrombin- antithrombin complex(TAT) during the perioperative period of cardiopulmonary bypass(CPB) and the difference between the group applied with heparin-coated circuit and the group injected with heparin. Methods: 23 patients undergoing the mechanical prosthetic valves replacement were randomly divided into two groups, uncoated group (UCG, N=15) and heparin-coated group (HCG, N=8). The blood samples were collected at 5 minutes before CPB, 5 minutes after heparinization, 60 minutes after CPB was started, 30 minutes after protamine neutralization, 60 minutes after protamine neutralization, 4 hours and 12 hours after CPB. The levels of TAT was determined by ELISA and the activity of Factor X (FX:C) was detected by one stage coagulation assay. Results: The levels of TAT in these 23 patients during the perioperative period were significantly higher than that in healthy people, especially during CPB and after prostamine neutralization. FX:C was significantly decreased during CPB. The alteration trends of TAT and FX:C in these two groups were same while magnitude HCG was lower. Conclusion: Some extent of hypercoagulable state existed before operation, significantly excessive activation of coagulation and coagulation factors consumption existed in patients receiving CPB. High attention should be paid when the TAT-level reaches 600 μg/L after prostamine neutralization.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2003年第6期346-347,共2页
Chinese Journal of Thoracic and Cardiovascular Surgery
