摘要
目的研究房间隔缺损(ASD)患者介入关闭术后高凝血状态的机制及干预方法。方法观察82例ASD患者介入治疗前后抗凝血酶-III(antithrombin-III,AT-III)活性、纤维蛋白原(Fibrinogen,Fib)、D-二聚体(D-dimer,D-D)和组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)水平的变化以及肝素对它们的影响作用。结果介入关闭ASD的患者术后30min,血浆AT-III活性较术前明显下降(P<0.01),Fib、D-D和t-PA浓度较术前明显升高(P均<0.01)。术后第3天,血浆AT-III活性较封堵术前和术后30min下降更加明显(P均<0.01);Fib和D-D浓度较术后30min明显下降(P<0.01),但仍明显高于封堵术前(P<0.01);血浆t-PA浓度较术前和术后30min明显下降(P均<0.01)。ASD封堵术后30min血浆Fib、D-D和t-PA浓度与心导管在心血管内的操作时间呈正相关(r分别为0.464、0.758和0.251。P<0.01,P<0.01,P<0.05)。术后应用低分子肝素3d的患者在术后第3d,血浆AT-III活性明显高于术后只应用1d低分子肝素的患者(P<0.01),Fib和D-D浓度明显低于术后只应用1d低分子肝素的患者(P均<0.01)。结论介入关闭ASD的患者术后抗凝血因子活性下降,促凝血因子活性增强,产生了高凝血状态,术后低分子肝素的应用可以减轻高凝血状态。
[Objective] This study sought to determine the mechanism and treatment of hypercoagulative state in patients after catheter closure of atrial septal defect （ASD）. [Methods] We studied 82 patients undergoing catheter closure of ASD. The levels of antithrombin-III （AT-III）, fibrinogen （Fib）, D-dimer （D-D） and tissue-type plasminogen activator （t-PA） were measured before ASD closure, at the 30th minute and on the third day after ASD closure. The effect of hcparin on the levels of AT-III, Fib, D-D and t-PA were determined. [Results] At 30th minute after ASD closure there were significantly lower AT-III activity and higher levels of Fib, D-D and t-PA than those before ASD closure （P 〈0.01）. AT-III activity and t-PA levels decreased significantly on the third day after ASD closure compared with those before ASD closure and at 30th minute after ASD （P 〈0.01）. On the third day after ASD closure there were significantly lower levels of Fib and D-D than those at 30th minute after ASD closure （P 〈0.01） but higher levels of Fib and D-D than those before ASD closure （P 〈0.01）. There was positive relationship between levels of Fib, D-D and t-PA and duration of catheter performance in vessel and heart （r was 0.464, 0.758 and 0.251 respectively. P 〈0.01,P 〈0.01,P 〈0.05）. On the third day after ASD closure there were higher AT-III activity and lower levels of Fib and t-PA in patients treated with low-molecular-weight heparin for three days than those in patients treated with low-molecular-weight heparin for only one day （P 〈0.01）. [Conclusions] There was a hypereoagulative state in patients for decreasing activation of anticoagulation and increasing activation of coagulation after catheter closure of ASD. The hypereoagulative state in patients after catheter closure of ASD could be relieved by treating with low-molecular-weight heparin.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2009年第3期398-401,408,共5页
China Journal of Modern Medicine
基金
国家自然科学基金(No:30470709)
关键词
房间隔缺损
介入关闭
高凝血状态
atrial septal defect
catheter closure
hypercoagulative state
