CAJ | 학술논문

　　目的观察血小板冷沉淀联合输注对长时间体外循环（CPB）患者各项凝血指标及术中、术后出血量的影响。方法将160例患者随机分为常规疗法组（A组）、血小板组（B组）、冷沉淀组（C组）和血小板联合冷沉淀组（D组）。测定CPB 前、CPB 结束中和肝素后10 min、1 h、2 h、4 h 激活全血凝固时间（ACT）、凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D唱二聚体；记录四组术中出血量、手术后2 h、4 h引流量。结果体外循环后4 h，A、B、C组ACT、PT、APTT均长于D组（P＜0．05）；A、B组FIB低于C组、D组（P均＜0．05）；停机后3 h、4 h，D组D唱二聚体低于A组、B组、C组（P＜0．01）；D组较A组术中出血量、手术后2 h、4 h引流量减少（P＜0．05）。结论长时间体外循环后，早期、足量使用血小板联合冷沉淀输注能使CPB后延长的ACT、PT、APTT明显缩短，可增加血浆FIB含量，改善患者的凝血功能，减少术中、术后出血量。
　　목적관찰혈소판랭침정연합수주대장시간체외순배（CPB）환자각항응혈지표급술중、술후출혈량적영향。방법장160례환자수궤분위상규요법조（A조）、혈소판조（B조）、랭침정조（C조）화혈소판연합랭침정조（D조）。측정CPB 전、CPB 결속중화간소후10 min、1 h、2 h、4 h 격활전혈응고시간（ACT）、응혈매원시간（PT）、부분응혈활매시간（APTT）、섬유단백원（FIB）、D창이취체；기록사조술중출혈량、수술후2 h、4 h인류량。결과체외순배후4 h，A、B、C조ACT、PT、APTT균장우D조（P＜0．05）；A、B조FIB저우C조、D조（P균＜0．05）；정궤후3 h、4 h，D조D창이취체저우A조、B조、C조（P＜0．01）；D조교A조술중출혈량、수술후2 h、4 h인류량감소（P＜0．05）。결론장시간체외순배후，조기、족량사용혈소판연합랭침정수주능사CPB후연장적ACT、PT、APTT명현축단，가증가혈장FIB함량，개선환자적응혈공능，감소술중、술후출혈량。
Objective To observe platelet transfusion on long joint cryoprecipitate various coagulation parameters in patients with cardiopulmonary bypass ( CPB) and intraoperative and postoperative bleeding effect . Methods 160 patients were randomly divided into four groups:conventional therapy group (A),platelet group (B),cryoprecipitate(C)and platelets,cryoprecipitate combined group(D).Before CPB,CPB and heparin after the end of 10 minutes,1 h,2 h,4 h activated clotting time(ACT),prothrombin time(PT),partial thromboplastin time (APTT),fibrinogen(FIB) and D-dimer were measured;blood loss volume,postoperative drainage volume of 2,4 hours were recorded.Results After cardiopulmonary bypass 4 h,ACT,PT,APTT of group A,B,C were longer than group D(P<0.05);FIB of group A,B were lower than group C and group D (all P<0.05);shutdown 3 h,4 h,D-dimer of group D was lower than group A,B and C(P<0.01);The intraoperative blood loss and postoperative suction drainage within 2 to 4 hours of group D were lower than group A (P<0.05).Conclusions Long after CPB,early enough to use platelet transfusions make joint cryoprecipitate ,ACT,PT,APTT prolonged after CPB were significantly shorter,plasma FIB levels were increased,the patient′s clotting function were improved and intraoperative and postoperative blood loss were reduced .