天津医药

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非体外循环冠脉搭桥术后不同治疗方案对凝血功能的影响

钱兆洋1,王赞鑫1,姜月梅2,门剑龙2,魏民新1   

  1. 1. 天津医科大学总医院心血管外科
    2. 天津医科大学总医院
  • 收稿日期:2012-09-24 修回日期:2013-03-05 出版日期:2013-06-15 发布日期:2013-06-15
  • 通讯作者: 魏民新

Effects of Different Treatments on the Coagulation Function after Off-Pump Coronary Artery Bypass Grafting

QIAN Zhaoyang 1,WANG Zanxin 1,JIANG Yuemei 1,Men Jianlong1,WEI MIN XIN2   

  1. 1. Laboratory Department, General Hospital of Tianjin Medical University,
    2. Department of Cardiovascular Surgery, General Hospital of Tianjin Medical University
  • Received:2012-09-24 Revised:2013-03-05 Published:2013-06-15 Online:2013-06-15
  • Contact: WEI MIN XIN

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摘要： 【摘要】目的  探讨不同治疗方案对非体外循环冠状动脉搭桥术（OPCAB）后VII因子（FⅦ）、血管性血友病因子（vWF）、D-二聚体（D-dimer）和纤溶酶原激活物抑制物-1（PAI-1）的影响。方法  根据阿司匹林和低分子肝素联合使用时间将60例OPCAB 患者随机分为A、B 组。于术前及术后4、14 d，采用酶联免疫吸附试验（ELISA）发色底物法检测FVII和vWF，双抗体夹心法测定PAI-1，免疫渗滤法检测D-dimer。术后1、3个月门诊复查D-dimer，并进行比较分析。结果  术后4 d 2组患者FVII降低，vWF和PAI-1升高，均于术后14 d基本恢复至术前水平（均P <0.05），3个指标组间差异无统计学意义（均P > 0.05）。D-dimer术后4 d~1个月显著升高，术后3个月时降至接近术前水平。且除术后14 d、1个月B组明显低于A组外，其余时点2组间差异均无统计学意义（P > 0.05）。结论  OPCAB后患者出现一定程度的凝血、纤溶亢进状态，术后延长低分子肝素使用时间对FⅦ、vWF和PAI-1在术后14 d内变化影响不明显，可降低D-dimer。

关键词: 冠状动脉旁路移植术, 非体外循环, 肝素, 低分子量, VII因子, von Willebrand因子, 纤溶酶原激活物抑制物1, D-二聚体

Abstract: [Abstract]   Objective   To investigate effects of different treatment options on the influence of factor Ⅶ(FⅦ), Von
Willebrand factor (vWF), D-dimer and plasminogen activator inhibitor-1 (PAI-1) after off-pump coronary artery bypass grafting (OPCAB). Methods    Sixty patients were divided into two groups: A group and B group, according to the using time of low-molecular-weight heparin (LMWH) and aspirin. The levels of FVII and vWF were examined by ELISA-chromogenic substrate method before operation, 4-d and 14-d after operation. The level of PAI-1 was detected by sandwich technique,and D-dimer was detected by immunogold filtration assay. The level of D-dimer was reviewed in 1 month and 3 months after surgery. All results were analyzed between two groups. Results   The value of FⅦdecreased significantly 4-d after operation in two groups of patients, vWF and PAI-1 increased significantly and returned to preoperative level on the 14-d after operation (P < 0.05). There were no significant differences in three indicators between two groups (P > 0.05). The level of D-dimer increased until 1 month after surgery and went back to preoperative level in 3 months after operation. There was a significantly lower level of D-dimer in B group than that of A group on the 14th day and 1 month after surgery (P < 0.05). Conclusion   Patients have higher levels of coagulation and fibrinolysis function after OPCAB. Postoperative extend the use of LMWH has no impact on FⅦ, vWF and PAI-1 in 14 days after surgery, but which can reduce the level of D-dimer.

Key words: coronary artery bypass, off-pump, heparin, low-molecular-weight, F VII, von Willebrand Factor, Plasminogen Activator Inhibitor 1, D-二聚体