Factors affecting perioperative hemostatic abnormalities in prolonged maxillofacial surgery

长时间颌面手术围手术期止血异常的影响因素

• 批准号: 11672020
• 负责人: TAKASUGI Yoshihiro
• 金额: $ 2.3万
• 依托单位: Nippon Dental University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11672020/
• 关键词: prolonged surgery; hypercoagulability; tissuo factor; interleukin 6; vascular injury; malignant tumor; 血液線溶活性; 組織型プラスミノゲンアクチベーター; プラスミンα2プラスミンインヒビター複合体; サイトカイン; トロンボモジュリン; 血液凝固

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

我们认为止血异常是在长时间的手术过程中发生的。围手术期高凝被认为是由于基础疾病、软组织侵袭、内皮细胞侵袭等导致释放组织因子（TF）进入循环的结果。然而，在长时间的手术中，导致止血异常的因素尚不清楚。在本研究中，我们评估了分子标记物的围手术期变化，目的是研究长时间手术中导致止血异常的因素。受试者接受了长时间的恶性手术，持续时间超过8小时，伴有肿瘤清扫，根治性颈部清扫和游离皮瓣植入重建。在麻醉开始时、桡骨廓清结束时、组织移植结束时、麻醉结束时及术后第1天、第2天测定凝血酶原片段1+2 （F1+2）、白细胞介素6 （IL-6）、TF、组织因子途径抑制剂（TFPI）、血栓调节蛋白（YM）、α2-纤溶蛋白抑制剂-纤溶蛋白复合物（PAP）、组织型血浆等分子标志物。术中F1+2值明显升高，术后下降2。术中IL-6和tPA值也升高，麻醉结束时达到最大值3。术中、术后TF、TFPI、TM、PAP均无明显变化。这些结果表明，由于手术侵入而释放的细胞因子影响了术中高凝性，是导致止血异常的因素之一。此外，手术侵入必须影响内皮细胞以释放tPA。然而，由于已被认为是术中高凝的主要因素的TF，而血管明显损伤程度所释放的TM并没有明显改变，因此颌面部长时间手术中软组织的侵袭对形成高凝性一定不重要。少