肝脏疾病患者围术期纤溶功能检测的临床意义

目的　观察肝脏疾病患者围术期纤溶功能的动态变化 ,为指导临床合理使用抗凝止血类药物提供依据。方法　应用双抗体夹心酶联免疫吸附法和发色底物法分别检测 2 3例各种肝脏疾病患者麻醉前、术中、术后 4h及术后 1d等 4个时间点外周血D 二聚体、组织型纤溶酶原激活物 (t PA)和纤溶酶原激活物抑制物 (PAI)的含量。结果　肝脏疾病患者血浆D 二聚体和t PA的含量在术中及术后 1d内均较麻醉前有明显升高 (P <0 0 1 ) ,虽然t PA的含量在术后 1d时较术后 4h有下降 ,但没有显著性差异 (P >0 0 5 )。血浆PAI的含量在术中和术后 4h与麻醉前相比有显著的下降 (P <0 0 5 ) ,术后 1d开始有显著的上升 (P <0 0 5 )。结论　肝脏疾病患者术中、术后均处于继发性外源纤溶亢进 ,可能是肝脏疾病手术中及术后出血的主要原因之一。提示术中和术后适量使用抗纤溶类止血药可能较凝血酶类止血药更为恰当

Clinical significance of perioperative measurements of fibrinolysis function in patients with liver diseases

Objective To observe the perioperative changes of fibrinolysis function in patients with liver diseases and discuss the clinical significance in the use of anticoagulation in patients undergoing liver operation.Methods Plasma D dimer(DD),tissue type plasminogen activator(tPA) and plasminogen activator inhibitor(PAI)levels in 23 patients with liver diseases were determined before anesthesia,during operation,4 hours after operation and on the first postoperative day respectively.Results The plasma DD ant tPA levels in patients with liver diseases during operation and on the first postoperative day were significantly higher than those before anesthesia( P< 0 01).Although the plasma tPA level on the first postoperative day was lower than that 4 hours after operation,no significant difference was found.The plasma PAI levels during operation and 4 hours after operation were significantly lower than those before anesthesia,but began to increase on the first postoperative day( P< 0 05).Conclusion Secondary external fibrinolysis during and after operation may play an important role in haemorrhage during and after liver operation in patients with liver diseases.