摘要
目的探讨胸部恶性肿瘤患者术后凝血功能变化与下肢静脉血栓形成的相关性。方法选择2008年1月至2010年4月接受胸部恶性肿瘤切除手术的患者52例,术前及术后3d内行下肢静脉超声检查;术前、术毕、术后24h采集静脉血,测定血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)等指标。结果 52例患者术毕及术后24hPLT计数分别为(125±56)×109/L、(128±54)×109/L,均较术前的(212±73)×109/L显著下降(P<0.01)。术后24hFIB、D-二聚体(DD)分别为(5.62±0.95)g/L、(603±178)mg/L,显著高于术前的(3.81±0.79)g/L、(140±69)mg/L(P<0.05,P<0.01)。手术后超声检查下肢静脉血栓发生率21.15(11/52),其中有症状的下肢静脉血栓1例(1.92)。下肢静脉血栓阳性组与阴性组的各组患者手术前和术毕各项凝血指标无显著性差异(P>0.05);阳性组术后24hFIB为(6.38±1.04)g/L,明显高于阴性组的(5.47±0.87)g/L(P<0.05),APTT为(26.10±3.46)s,明显低于阴性组的(29.70±3.93)s(P<0.05)。结论接受胸部恶性肿瘤手术患者术毕即存在凝血功能障碍,术后24h进入高凝状态,同时伴有纤溶亢进;围手术期凝血功能变化与术后下肢静脉血栓形成具有相关性。
Objective To observe the changes of blood coagulation function after thoracic surgery for malignant tumor,and to explore its association with postoperative venous thrombosis in lower limbs.Methods Fifty-two patients who were operated for thoracic malignant tumor were included.All patients,without evidence of venous thrombosis in lower limbs by sonography before surgery were examined repeatedly for venous thrombosis within 3 days after operation.Several blood coagulation markers were determined before operation（T1）,just after operation（T2） and 24 hours after surgery（T3）.Results The platelet count of all patients decreased after surgery（P 0.01）.The fibrinogen increased at T3（P 0.05）.The D-dimer（DD） increased after surgery（P 0.01）.There were 11 patients（21.15%） whom were found to have venous thrombosis in lower limbs after surgery,including 1 case（1.92%） with pain.There was no significant difference（P 0.05） in PLT,PT,FIB,APTT,TT,DD at T1 and T2 between the positive group and negative group based on the sonography.Whereas,FIB was significantly higher（P 0.05） and APTT was significantly lower（P 0.05） in the positive group than in the negative group at T3.Conclusions Patients have dysfunction of blood coagulation just after the completion of thoracic operation for malignant tumor.24 hours after surgery,hypercoagulate state accompanied by hyper-fibrinolysis state have been observed in these patients.These changes are associated with postoperative venous thrombosis in lower limbs.
出处
《北京医学》
CAS
2011年第7期544-546,共3页
Beijing Medical Journal
关键词
胸部恶性肿瘤
手术
凝血功能
下肢静脉血栓形成
Malignant tumor Thoracic operation Blood coagulation function Venous thrombosis in lower limbs
