CHANGES OF BLOOD COAGULATION-FIBRINOLYSIS ACTIVITY DURING PROLONGED OPERATION

长时间手术期间凝血纤溶活性的变化

• 批准号: 07457497
• 负责人: TAKASUGI Yoshihiro
• 金额: $ 4.74万
• 依托单位: NIPPON DENTAL UNIVERSITY,SCHOOL OF DENTISTRY AT TOKYO
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1995
• 资助国家: 日本
• 起止时间: 1995 至 1996
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07457497/
• 关键词: PROLONGED OPERATION; BLOOD COAGULATION-FIBRINOLYSIS SYSTEM; HEPARIN; HYPERCOAGULABILITY; 長時間麻酔; 血液凝固活性; 線溶活性; 全身麻酔

Background : Although it is thought that prolonged operation is one of the factors to cause systematic hypercoaglability, the perioperative alternation of blood coagulation-fibrinolysis system has not been reported. The aims of this study were to clarify the changes of coagulation-fibrinolysis activity during prolonged operation and the effect of heparin therapy by using molecular markers.Method : The subjects were the patients with oral cancer who underwent the operation which took more than 10 hours and included tumor excision and reconstruction using a free flap. The subjects were divided into two random groups, heparin group consisting of continuous intravenous heparin infusion which was administrated from the starting point of micro surgery to the end of anesthesia and control group ; without heparin therapy.The dose of heparin was controlled by activated partial thromboplastin time (APTT) showing the range 50-70sec. We measured prothrombin time (PT), APTT,fibrinogen antithrombin … More III (ATIII), thrombin-antithrombin IIIcomplex (TAT), fibrinopeptide A (FPA), prothrombin fragment1+2 (F1+2), soluble fibrin monomer complex (SFMC), D-dimer, plasmin-a2 plasmin inhibitor complex (PIC) and heparin concentration from the stating point to the end point of anesthesia.Result : Coagulation markerlevels increased remarkably depending on the progress of the operation in all cases of the control group, and 3 cases of control group showed the activation of fibrinolysis. In the heparin group, anticoagulant effect by heparin appeared clearly after the start of heparin infusion. Also 3 cases of heparin group showed the activation of fibrinolysis, but the degree of the activation was slighter than in control group. Heparin concentration was showing underneath 0.2U/ml, and there was slight crrelation between APTT and heparin concentration(r=0.62).Conclusion : It is clear that blood coagulation-fibrinolysis system is activated from the early stage of prolonged operation, and continuous intravenous heparin infusion is effective as an anticoagulant therapy during operation. Less

背景：虽然手术时间延长被认为是引起系统性高凝的因素之一，但围手术期凝纤溶系统的改变尚未见报道。本研究的目的是通过分子标记来阐明长时间手术中凝血纤溶活性的变化和肝素治疗的效果。方法：以口腔癌患者为研究对象，手术时间超过10小时，包括肿瘤切除和游离皮瓣重建。随机分为两组，肝素组从显微手术开始至麻醉结束持续静脉滴注肝素，对照组持续静脉滴注肝素；没有肝素治疗。肝素的剂量由活化的部分凝血活素时间（APTT）控制，其范围为50-70秒。我们测量了从麻醉起始点到麻醉结束点的凝血酶原时间（PT）、APTT、纤维蛋白原抗凝血酶III （ATIII）、凝血酶-抗凝血酶III复合物（TAT）、纤维蛋白肽A （FPA）、凝血酶原片段1+2 （F1+2）、可溶性纤维蛋白单体复合物（SFMC）、d -二聚体、纤溶酶a2纤溶酶抑制剂复合物（PIC）和肝素浓度。结果：对照组所有患者凝血标志物水平均随手术进展明显升高，对照组3例患者出现纤溶激活。在肝素组中，肝素的抗凝作用在肝素输注开始后明显显现。肝素组也有3例出现纤溶活化，但活化程度较对照组轻。肝素浓度低于0.2U/ml， APTT与肝素浓度有轻微的相关性（r=0.62）。结论：明显凝纤溶系统在手术早期就被激活，术中持续静脉滴注肝素作为抗凝治疗是有效的。少

项目成果

Takasugi Yoshihiro: "Evaluation of Blood Coagulation and Fibrinolysis in a Patient with Pre-DIC after Operation for a Malignant Tumor" J Ppn Dent Soc Anesthesiol. 24 (3). 504-511 (1996)

Takasugi Yoshihiro：“恶性肿瘤手术后 DIC 前期患者的凝血和纤维蛋白溶解的评估”J Ppn Dent Soc Anesthesiol。

高杉嘉弘: "術後にpre-DIC状態を併発した悪性腫瘍手術症例における血液凝固活性の推移" 日本歯科麻酔学会雑誌. 24(3). 504-511 (1996)

Yoshihiro Takasugi：“恶性肿瘤手术后并发DIC状态的血液凝固活性的变化”日本牙科麻醉学会杂志24（3）（1996）。