心肺复苏后72h内监测血管性血友病因子凝血的临床意义

目的:探讨心脏骤停心肺复苏(CPR)后72h内血管性血友病因子(VWF)凝血的动态变化及意义。方法:35例心脏骤停心肺复苏患者,依复苏最终效果分为A1组25例:初期复苏成功,自主循环(ROSC)建立≥72h但最终死亡;A2组10例:复苏成功,存活出院。于ROSC24h、48h及72h检测VWF、D-二聚体(D-dimer)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)水平的动态变化。结果:A1组ROSC24hVWF、D-D、PT及APTT水平高于A2组(P0.05),ROSC48h各项指标水平变化达峰值且A1高于A2组;ROSC72hA2组各项指标明显改善与A1组比较差异有统计学意义(P0.05)。结论:心跳骤停成功心肺复苏患者存在VWF以及内源外源性凝血功能紊乱。其变化对病情严重程度及预后有重要的判断价值。

Study on dynamic change of coagulation and von Willebrand factor and its clinical significance after cardiopulmonary resuscitation

Objective：To investigate dynamic changes of coagulation and von Willebrand factor and explore its correlation with prognosis of cardiopulmonary resuscitation.Methods：35 CPR patients were divided into 2 groups according to the result of recovery：A1 group：25 successful recovery patients in the initial stage and their restoration of spontaneous circulation（ROSC）last for 72 h at least,but dead ultimately;A2 group：10 successful recovery patients who are survival to leave hospital at last.Then the dynamic changes of von Willebrand factor（VWF）,D-dimer（D-dimer）,prothrombin time（PT）,activated partial thromboplastin time（APTT） are recorded at ROSC 24 h,48 h and 72 h.Results：At ROSC 24 h and 48 h the levels of VWF,D-D,PT and APTT are higher in group A1 compared with group A2（P 0.05）;All indicators change dynamically with time and peak at ROSC 48 h.The change of all indicators in group A1 is more obvious than group A2;At ROSC 72 h all indicators are improved obviously in group A2,with significant difference compared with group A1（P 0.05）.Conclusion：The dynamic change of Von Willebrand factor,endogenous and extrinsic coagulation disorder are found in the CPR patients.Their dynamic changes in the course of CPR are valuable to assess the severity of patients＇condition and prognosis.