中国医学创新目次围手术期法洛四联症患者血液流变学变化与术后出血关系(1)
【摘要】 目的：探讨围手术期法洛四联症患者血液流变学变化与术后出血关系。方法：选取赣南医学院第一附属医院2011年6月-2014年12月接收的62例法洛四联症患者的临床资料，根据引流量分成观察组6例即术后出血≥3 mL/(kg·h)和对照组56例即术后未出血≤3 mL/(kg·h)，记录并比较两组术前及术后1 d的全血黏度、血浆黏度、红细胞比容和血浆纤维蛋白原。结果：两组术后的红细胞比容、全血黏度均明显低于术前，而纤维蛋白原高于术前，手术前后比较差异均有统计学意义(P<0.05)；观察组术后全血黏滞度、红细胞比容、血浆黏滞度、纤维蛋白原均明显低于对照组，两组比较差异均有统计学意义(P<0.05)。结论：围手术期法洛四联症患者血液异常，血液流变学指标异常可作为术后出血的诊断依据之一，术后对血液流变学变化明显患者补充冷沉淀或各种凝血因子是减少术后出血的重要途径。
【关键词】 围手术期； 法洛四联症； 血液流变学变化； 术后出血关系
【Abstract】 Objective：To investigate the relationship between the hemorheology and postoperative bleeding of perioperative tetralogy of Fallot patients.Method：62 patients with tetralogy of Fallot were selected in the First Affiliated Hospital of Gannan Medical College from June 2011 to December 2014 ， according to drainage they were divided into the observation group for 6 cases which postoperative bleeding≥3 mL/(kg·h) and the control group for 56 cases which no postoperative hemorrhage ≤3 mL/(kg·h)，then whole blood and plasma viscosity， hematocrit and plasma fibrinogen in the period of preoperative and postoperative of them were recorded and compared.Result：In the postoperative time，hematocrit and whole blood viscosity of two groups were significantly lower than those in the preoperative time，while the fibrinogen of two groups was significantly higher than that in the preoperative time， the differences were statistically significant(P<0.05). In the postoperative time ，the whole blood viscosity， hematocrit，plasma viscosity and fibrinogen of observation group were significantly lower than the control group， the differences were statistically significant (P<0.05).Conclusion：Perioperative tetralogy of fallot patients with abnormal blood，the abnormal blood rheology can be used as one basis for diagnosis of postoperative bleeding，to supplement the hemorheology patients’ cryoprecipitate or various coagulation factors after surgery is an important way to reduce obvious postoperative bleeding.
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【Key words】 Perioperative： Tetralogy of fallot； Hemorheology； Postoperative bleeding
First-author’s address：The First Affiliated Hospital of Gannan Medical University，Ganzhou 341000，China
doi：10.3969/j.issn.1674-4985.2015.32.017
法洛四联症(Tetralogy of Fallot，TOF)属于青紫型先天性心脏病，其病理畸形表现为主动脉骑跨、肺动脉狭窄、室间隔缺损和右心室肥厚，是临床中较为常见的复杂型先天性心脏病，居于婴幼儿紫绀型心脏畸形首位，在我国发病率约占青紫型先天性心脏病的55%，占先天性心脏病的10%[1-2]。术后常发生胸腔内渗血，甚至大出血，严重威胁患者的生命健康，往往需要大量输血或二次开胸止血，才能挽救患者的生命，增加了患者手术的危险程度及经济和心理负担[3-4]。本次研究主要监测围手术期法洛四联症患者血液流变学指标，寻找出围手术期患者血液流变学指标的变化规律，分析术后出血与血液流变学变化之间的关系，进而采取相应的方法和措施防治法洛四联症患者术后出血的发生，并作如下报告。, 百拇医药(罗志方 江美兰 李章红)
【关键词】 围手术期； 法洛四联症； 血液流变学变化； 术后出血关系
【Abstract】 Objective：To investigate the relationship between the hemorheology and postoperative bleeding of perioperative tetralogy of Fallot patients.Method：62 patients with tetralogy of Fallot were selected in the First Affiliated Hospital of Gannan Medical College from June 2011 to December 2014 ， according to drainage they were divided into the observation group for 6 cases which postoperative bleeding≥3 mL/(kg·h) and the control group for 56 cases which no postoperative hemorrhage ≤3 mL/(kg·h)，then whole blood and plasma viscosity， hematocrit and plasma fibrinogen in the period of preoperative and postoperative of them were recorded and compared.Result：In the postoperative time，hematocrit and whole blood viscosity of two groups were significantly lower than those in the preoperative time，while the fibrinogen of two groups was significantly higher than that in the preoperative time， the differences were statistically significant(P<0.05). In the postoperative time ，the whole blood viscosity， hematocrit，plasma viscosity and fibrinogen of observation group were significantly lower than the control group， the differences were statistically significant (P<0.05).Conclusion：Perioperative tetralogy of fallot patients with abnormal blood，the abnormal blood rheology can be used as one basis for diagnosis of postoperative bleeding，to supplement the hemorheology patients’ cryoprecipitate or various coagulation factors after surgery is an important way to reduce obvious postoperative bleeding.
, http://www.100md.com
【Key words】 Perioperative： Tetralogy of fallot； Hemorheology； Postoperative bleeding
First-author’s address：The First Affiliated Hospital of Gannan Medical University，Ganzhou 341000，China
doi：10.3969/j.issn.1674-4985.2015.32.017
法洛四联症(Tetralogy of Fallot，TOF)属于青紫型先天性心脏病，其病理畸形表现为主动脉骑跨、肺动脉狭窄、室间隔缺损和右心室肥厚，是临床中较为常见的复杂型先天性心脏病，居于婴幼儿紫绀型心脏畸形首位，在我国发病率约占青紫型先天性心脏病的55%，占先天性心脏病的10%[1-2]。术后常发生胸腔内渗血，甚至大出血，严重威胁患者的生命健康，往往需要大量输血或二次开胸止血，才能挽救患者的生命，增加了患者手术的危险程度及经济和心理负担[3-4]。本次研究主要监测围手术期法洛四联症患者血液流变学指标，寻找出围手术期患者血液流变学指标的变化规律，分析术后出血与血液流变学变化之间的关系，进而采取相应的方法和措施防治法洛四联症患者术后出血的发生，并作如下报告。, 百拇医药(罗志方 江美兰 李章红)