Factors affecting perioperative hemostatic abnormalities in prolonged maxillofacial surgery

据认为，在长时间的手术过程中会出现止血异常。围术期高凝状态被认为是基础疾病的结果，软组织侵袭、内皮细胞侵袭等导致组织因子(TF)释放到循环中。然而，目前尚不清楚是什么因素导致了长时间手术中的止血异常。在本研究中，我们评估了围手术期分子标志物的变化，以探讨在长期手术中导致止血异常的因素。这些受试者接受了长期的恶性手术，持续时间超过8小时，同时进行了肿瘤解剖、根治性Neek解剖和游离皮瓣植入术。凝血酶原片段F1+2、IL-6、Tf、组织因子途径抑制物、血栓调节蛋白、α2-纤溶酶抑制物-纤溶酶复合体、组织型纤溶酶…的分子标志物分别于麻醉开始时、放射状Neek解剖结束时、组织移植结束时、麻醉结束时及术后第1、2天测定血浆中tPA的含量。IL-6和tPA也在术中升高，在麻醉结束时达到最大。术中、术后Tf、TFPI、TM、PAP无明显变化，提示手术侵袭引起的循环释放细胞因子影响了术中高凝状态，是导致术中止血异常的因素之一。此外，手术侵袭必须影响内皮细胞才能释放tPA。然而，由于Tf已被认为是手术中高凝的主要因素，而严重程度的血管损伤所释放的TM没有明显的变化，因此在颌面部长期手术中软组织侵袭肯定不是形成高凝状态的重要因素。较少

It is believed that the hemostatic abnormalities occur during prolonged surgery. Perioperative hypercoagulability is recognized as a result of the basic disease, the releasing tissue factor (TF) into the circulation due to the soft tissue invasion, the invasion of endothelial cell and so on. However, it has been unknown what factors eause the hemostatic abnormalities during prolonged surgery. In this study, we evaluated the perioperative changes of molecular markers for the purpose of the investigation of investigation of factors causing hemostatic abnormalities during prolonged surgeryThe subjects was undergone prolonged malignant surgery, more than eight hours of duration, accompanied with a tumor dissection, a radical neek dissection and a reconstruetion by a free flap implantation. Molecular markers of prothrombin fragment 1+2 (F1+2), interleukin 6 (IL-6), TF, tissue factor pathway inhibitor (TFPI), thrombomodulin (YM), α2-plasmin inhibitor-plasmin complex (PAP), tissue-type plasmi … More nogen activator (tPA) were measured at the time of anesthesia start, the end of radial neek dissection, the end of tissue transplantation, the end of anesthesia, and the first and seeond postoperative daysWe obtained the following results :1. The values of F1+2 significantly increased during operation and declined postoperatively2. The values of IL-6 and tPA also increased intraoperatively and reached the maximum at the end of anesthesia3. The values of TF, TFPI, TM and PAP did not significant changed during and postoperatively.These results reveal that the releasing cytokines into the circulation due to the surgical invasion influenced the hypercoagulability during the surgery, and is one of the factors causing hemostatic abnormalities. Furthermore, the surgical invation must enfluence to the endthelium to release tPA.However, since TF that has been recognized as a main factor to the hypercoagulation during surgery, and TM that is released by the significant degree of vascular injury did not significantly changed, the soft tissue invasion must not important to form the hypercoagulability during prolonged surgery in maxillofacial region. Less