Factors affecting perioperative hemostatic abnormalities in prolonged maxillofacial surgery

据认为，止血异常发生在长期手术期间。围手术期高凝状态被认为是基础疾病、软组织浸润、内皮细胞浸润等导致组织因子（TF）释放入循环所致，但长期手术中止血异常的原因尚不清楚。本研究通过观察围手术期分子标志物的变化，探讨长时间手术中引起止血异常的因素。受试者接受了长时间恶性肿瘤手术，手术时间超过8小时，同时进行了肿瘤切除、根治性颈淋巴结清扫和游离皮瓣移植。凝血酶原片段1+2（F1+2）、白细胞介素6（IL-6）、TF、组织因子途径抑制物（TFPI）、血栓调节蛋白（YM）、α2-纤溶酶前体-纤溶酶复合物（PAP）、组织型纤溶酶（PAI）等分子标志物， ...更多信息 分别于麻醉开始时、桡侧颈淋巴清扫术结束时、组织移植术结束时、麻醉结束时、术后第1天和第2天测定血浆tPA。F1+2值在手术期间显著增加，术后下降2。IL-6和tPA的值也在术中增加，并在麻醉结束时达到最大值3。TF、TFPI、TM和PAP在手术前后无明显变化，提示手术侵入引起的细胞因子释放进入循环，影响了手术过程中的高凝状态，是引起止血异常的因素之一。而手术中被认为是引起高凝状态主要因素的TF和因血管损伤而释放的TM并没有明显变化，说明软组织的侵袭对颌面部手术中高凝状态的形成并不重要。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