腹部大手术患者手术前后凝血指标的变化

目的观察腹部大手术患者手术前后凝血指标的变化,并探讨其临床意义。方法检测对照组60例体检者和观察组67例腹部大手术者手术前后血小板计数(PLT)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)水平,并进行比较。结果(1)腹部大手术患者术前PLT、PT、TT、APTT与对照组比较无显著性差异(P>0.05),FIB则高于对照组(P<0.05);(2)术后观察组PLT水平低于对照组(P<0.01),而PT、TT、APTT较对照组延长(P<0.05,P<0.01),FIB与对照组比较无显著性差异(P>0.05);(3)手术后PLT和FIB显著低于手术前(P<0.05,P<0.01);(4)术后死亡组PLT水平明显低于生存组(P<0.05),而PT、TT、APTT、FIB组间比较则无显著性差异(P>0.05)。结论腹部大手术者术前常呈高凝状态,术后则可呈现高凝、相对纤溶抑制或低凝,术后PLT减少是患者死亡的独立危险因素。

Changes of blood coagulation indexs pre- and post-operation in paitients with an abdominal major operation

Objective To observe the changes of blood coagulation indexes pre-and post-operation in patients with an abdominal major operation,and to study the clinical significance.Methods Platelet count(PC),Prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT) and fibrinogen(FIB) of 60 healthy individuals and 67 patients with an abdominal major operation were detected pre-and post-operation and compared.Results(1)Compared with control group,FIB level was higher in patients with an abdominal major operation before operation(P<0.05),there was no significant difference in PLT,PT,TT and APTT(P>0.05);(2)After operation,compared with control group,the PC was lower,and PT,TT,APTT were longer in observation group(P<0.05,P<0.01),while there was no significant difference in FIB(P>0.05);(3) FIB and PLT in the postoperative patients were lower than these in preoperative patients(P<0.05,P<0.01);(4) PLT was lower in patients of postoperative death than this in survivors(P<0.05),while there was no significant difference in PT,TT,APTT and FIB between two groups(P>0.05).Conclusion The patients with an abdominal major operation often are in hypercoagulabale state before operation,while the patients may be in after operation hypercoagulation,relative inhibition of fibrinolysis or hypocoagulation.Postoperative thrombocytopenia is an independent dangerous factor of death.