中国实用外科杂志

中国实用外科杂志

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动脉瘤病人围手术期凝血和纤溶状态及其与预后关系研究

陈铭铭1，章志丹1，高艳红2，栾正刚1，张晓娟1，朱承睿1，潘洁仪1，马晓春1   

  1. 1中国医科大学附属第一医院重症医学科，辽宁沈阳 110001；2吉林省柳河医院ICU，吉林通化 135300
  • 出版日期:2015-02-01 发布日期:2015-01-23

  • Online:2015-02-01 Published:2015-01-23

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摘要：

目的    分析动脉瘤病人围手术期凝血与纤溶指标的变化特点及其与预后的关系。方法    回顾性分析2013年1-6月于中国医科大学附属第一医院重症医学科治疗的40例动脉瘤术后病人的临床资料，分析围手术期凝血及纤溶指标变化及其与预后的关系。结果   40例动脉瘤病人术后血小板及纤维蛋白原水平明显低于术前（P<0.05），ISTH评分平均为（3.4±1.5）分，共7例病人诊断为弥漫性血管内凝血。动脉瘤破裂病人的ISTH评分明显高于未破裂者（P<0.05）。ISTH评分与APACHEⅡ、SOFA评分呈正相关关系（r=0.704、0.694，P<0.05），ARDS、休克及死亡病人具有更高的ISTH评分。结论    动脉瘤病人围手术期凝血及纤溶系统激活，血小板及纤维蛋白原大量消耗，易发生出凝血功能障碍；ISTH评分高的病人更易发生器官功能损伤，且预后较差。

关键词: 动脉瘤, 凝血, 纤维蛋白溶解, 弥漫性血管内凝血

Abstract:

Clinical analysis of coagulation and fibrinolysis in perioperative period of aortic aneurysm        CHEN Ming-ming*，ZHANG Zhi-dan，GAO Yan-hong，et al. *Department of ICU, the First Affiliated Hospital of China Medical University，Shenyang 110001，China
Corresponding author：MA Xiao-chun，E-mail：xcma2972@sina.com
Abstract    Objective    To investigate the feature of coagulation and fibrinolysis in perioperative period of aneurysm and the relationship with prognosis. Methods    The clinical data of 40 patients with aneurysm hospitalized in Department of ICU, the First Affiliated Hospital of China Medical University from January 2013 to June 2013 were collected. The coagulation and fibrinolysis during perioperative period were analyzed. Results    The platelet and fibrinogen levels of all 40 patients were lower after the operation significantly（P<0.05）. The ISTH score was 3.4±1.5. A total of 7 patients were diagnosed as DIC. The ISTH score of patients with ruptured aneurysm were higher than those without rupture significantly（P<0.05）. The ISTH score was correlated with APACHE Ⅱ and SOFA score positively. The dead patients and those with ARDS or shock had higher ISTH score. Conclusion    The coagulation and fibrinolysis are activated during perioperative period, which causes large consumption of platelets and fibrinogen and prones to DIC. The patients with higher ISTH score prone to have organ damage and poor prognosis.

Key words: aneurysm, coagulation, fibrinolysis, disseminated intravascular coagulation（DIC）