体外循环与非体外循环冠状动脉旁路移植术后凝血功能的变化

目的探讨体外循环下冠状动脉旁路移植术(CCABG)和非体外循环下冠状动脉旁路移植术(OPCAB)后凝血功能的变化规律。方法选择2007年2月-12月择期行冠状动脉旁路移植术(CABG)的患者84例,其中CCABG34例,OPCAB50例。2组患者分别于术前及术后返回监护室即刻抽血测定血浆凝血酶原时间(PT)、血浆活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FB)、血浆凝血酶原活动度(PTA)、国际标准化比值(INR),记录两组患者术后同种异体输血量,并进行组内及组间比较。结果术前凝血功能两组无明显差异(P>0.05)。与术前相比,两组术后PT、TT、APTT延长,INR增高,PTA、FB降低,差异均有统计学意义(P<0.01);与OPCAB组比较,CCABG组术后PT、TT、APTT延长,INR增高,PTA降低更为明显,差异均有统计学意义(P<0.01或P<0.05),两组术后FB无显著性差异(P>0.05)。术后同种异体输血量CCABG组明显高于OPCAB组(P<0.01)。结论CABG对凝血功能均有一定的损害;与CCABG相比,OPCAB可在一定程度上保护凝血功能,减少同种异体输血量及其相应风险。

Changes of coagulation function in patients undergoing on-pump coronary or off-pump artery bypass grafting

Objective To approach the Changes of Coagulation function in patients undergoing on-pump coronary or off-pump artery bypass grafting. Methods Eighty-four selected patients undergoing coronary artery bypass were randomly assigned to two groups. 34 cases of conventional CABG (CCABG) and 50 cases of off-pump coronary bypass (OPCAB) from February to December 2007. Blood samples were collected at the preoperative day, and at the end of operation when patients came back to CCU immediately. PT, APTT, TT, FB, PTA, INR were also measured at that times. Allogeneic blood transfusion was recorded of the two groups. Results There were no significant differences in the patient's coagulation function data between two groups before surgery (P>0.05). The levels of PT, APTT, TT were longer and INR was higher and FB, PTA were lower in two groups at the end of operation than at the preoperative day (P<0.01). At the end of operation, the CCABG group's coagulation function data such as PT, APTT, TT were longer and INR were higher and PTA was lower than the OPCABG group showed that there were significant differences(P<0.01 or P<0.05).there was no significant differences in FB between two groups at the end of operation (P>0.05). CCABG group was higher than OPCABG group in Allogeneic blood transfusion (P<0.01). Conclusion CABG leads to adverse effects on coagulation function especially CCABG. OPCABG protects coagulation function which can reduce complication such as allogeneic blood transfusion and so on. The changes of coagulation function in CABG could help doctor to analyze surgery bleeding or not, and reduce risk that miscarriage of justice of reoperation for hemostasis.