Changes in the Hemostatic System of Patients With Acute Aortic Dissection Undergoing Aortic Arch Surgery
Changes in the Hemostatic System of Patients With Acute Aortic Dissection Undergoing Aortic Arch Surgery
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DOI：
10.1016/j.athoracsur.2015.08.047
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发表时间：
2016-03-01
影响因子：
4.6
通讯作者：
Zhang, Hong Jia
中科院分区：
文献类型：
--
作者：
Guan, Xin Liang;Wang, Xiao Long;Zhang, Hong Jia
背景。急性主动脉夹层患者的主动脉弓手术常伴有大量出血和异体血液制品的输血。然而，急性主动脉夹层和手术引起的凝血功能障碍的生理病理尚未得到精确的研究。本研究的目的是描述急性主动脉夹层接受主动脉弓手术患者围手术期止血系统的变化。本研究于2013年1月至2014年9月选取62例Stanford A型急性主动脉夹层急诊主动脉弓手术患者。在麻醉诱导（T0）、鼻咽最低温度（T1）、鱼精蛋白逆转（T2）、术后4小时（T3）和术后第一天（T4） 5个时间点，采用标准实验室检查、血浆纤维蛋白原水平和血栓弹性图对止血系统进行评估。研究结果表明，凝血因子在术前有消耗的趋势。手术和低温导致凝血因子、血小板计数和功能以及纤维蛋白原浓度和功能的逐渐降低。止血治疗后，虽然血小板计数持续偏低，但凝血因子和血小板功能恢复到接近术前水平。相比之下，纤维蛋白原浓度和功能仍明显低于术前水平。这项前瞻性分析的结果显示，急性主动脉夹层本身甚至在手术前就激活了止血系统。止血治疗后，纤维蛋白形成比血小板功能受损更严重。在这种情况下，我们建议止血治疗应侧重于快速和充分补充纤维蛋白原。因此，我们建议进一步提高纤维蛋白原浓度，以改善急性主动脉夹层患者的凝血功能。(C) 2016年由胸外科学会发布
Background. Aortic arch surgery for patients with acute aortic dissection is frequently complicated by excessive bleeding and transfusion of allogeneic blood products. However, the physiopathology of acute aortic dissection and surgery-induced coagulopathy has never been precisely studied. The aim of the present study is to describe the changes of the perioperative hemostatic system in patients with acute aortic dissection undergoing aortic arch surgery.Methods. Sixty-two patients undergoing emergent aortic arch surgery for Stanford type A acute aortic dissection were enrolled in this study from January 2013 to September 2014. The hemostatic system was evaluated using standard laboratory tests, plasma fibrinogen levels, and thromboelastogragh at 5 time points: anesthesia induction (T0), lowest nasopharyngeal temperature (T1), protamine reversal (T2), 4 h after surgery (T3), and on the first postoperative day (T4).Results. The study results revealed that clotting factors had a tendency to be consumed in the preoperative period. Surgery and hypothermia resulted in a progressive reduction in clotting factors, platelet counts, and function, as well as fibrinogen concentration and function. After hemostatic therapy, although platelet counts were constantly low, clotting factors and platelet function returned to nearly preoperative levels. In contrast, fibrinogen concentration and function were still significantly lower than preoperative levels.Conclusions. The results of this prospective analysis showed that acute aortic dissection itself activated the hemostatic system even before surgery. After hemostatic therapy, fibrin formation was more impaired than platelet function. In this setting, we proposed that hemostatic therapy should focus on rapid and sufficient supplementation of fibrinogen. Thus, we recommend further increases in fibrinogen concentration to improve coagulopathy in patients with acute aortic dissection. (C) 2016 by The Society of Thoracic Surgeons