CHANGES OF BLOOD COAGULATION-FIBRINOLYSIS ACTIVITY DURING PROLONGED OPERATION

背景资料：虽然认为手术时间延长是引起全身高凝状态的因素之一，但围手术期凝血-纤溶系统的变化尚未见报道。本研究的目的是阐明凝血-纤溶活性的变化，在长期的手术和肝素治疗的效果，通过使用分子markets.Method：受试者是谁接受了手术时间超过10小时，包括肿瘤切除和重建使用游离皮瓣的口腔癌患者。受试者随机分为两组，肝素组从手术开始至麻醉结束持续静脉输注肝素，对照组不输注肝素，肝素剂量由活化部分凝血活酶时间（APTT）控制，范围为50- 70秒。检测凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原抗凝血酶（FTT-AT ...更多信息 结果：（1）麻醉前、麻醉后、麻醉前、麻醉后、麻醉后、麻醉前、麻醉后、麻醉前、麻醉后、麻醉后、麻醉前、麻醉后、麻醉前、麻醉后、麻醉后、麻醉前、麻醉后、麻醉后、麻醉前、麻醉后、麻醉后、麻醉前、麻醉后、麻醉前、麻醉后、麻醉后、麻醉前、麻醉后对照组所有患者的凝血标志物水平随手术进展而明显升高，3例对照组患者出现纤溶激活。在肝素组中，肝素的抗凝作用在肝素输注开始后明显出现。肝素组有3例出现纤溶激活，但激活程度较对照组轻。肝素浓度在0.2U/ml以下，APTT与肝素浓度呈轻度相关（r=0.62）。结论：长时间手术早期即激活凝血纤溶系统，术中持续静脉输注肝素是有效的抗凝方法。少

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