术前纤维蛋白原单次目标给药对PLIF术中出血及凝血功能的影响

摘要

Objective To investigate the effect of preoperative single target administrating of fibrinogen(FIB)on the intraop-erative bleeding and coagulation function in posterior lumbar interbody fusion (PLIF)operation.Methods 60 cases of lumbar inter-vertebral disc herniation(LDH)undergoing elective PLIF operation were divided into two groups according to the preoperative FIB levels:normal control group(NC,FIB≥3.0 g/L,n=20)and low FIB group(FIB<3.0 g/L,n=40).The low FIB group was ran-domly re-divided into 2 groups:the low HIB control group(LC,n=20)and the preoperative single FIB administrating group(PF, n=20).After anesthesia induction,the PF group was given FIB;the LC and NC groups were given the same volume of saline solu-tion as solvent volume required by administrating FIB dose.The change of blood coagulation 4 indexes were detected and the activa-ted clotting time(ACT),coagulation time(CR)and platelet function(PF)were detected by the sonoclot analyzer before and after drug administrating.The bleeding amount was weighed after ending operation.Results The FIB concentration after administrating in the PF group was (3.75±0.23)g/L,which was significantly higher than (2.62±0.33)g/L in the NC group and (2.23±0.22) g/L in the LC group,the differences among 3 groups were statistically significant(P <0.05);the CR value after administrating in the PF group was (21.42±7.15)U/min,which was higher than (18.21±5.62)U/min in the NC group and (15.21±5.63)U/min in the LC group.The bleeding amount in the PF group was (516.74±135.53)g,which was lower than (660.71±119.34)g in the NC group and (726.72±160.47)g in the LC group,the difference among 3 groups had statistical significance(P <0.05).Conclusion Preoperative single target administrating of fibrinogen can effectively increase the FIB level,improve the blood coagulation func-tion and reduce the periaoperative bleeding amount.%目的：探讨术前纤维蛋白原（FIB）单次目标给药，对腰椎后路减压椎间植骨融合内固定术（PLIF）术中出血及凝血功能的影响。方法选择腰椎间盘突出症（LDH）择期做 PLIF 的患者60例，依据术前 FIB 水平分为 FIB≥3．0 g／L 组（NC 组， n＝20）和低 FIB 组（FIB＜3．0 g／L，n＝40），低 FIB 组再分为低 FIB 对照组（LC 组，n＝20）和术前 FIB 单次给药组（PF 组，n＝20）。PF 组于麻醉诱导完成后输入纤维蛋白原；LC、NC 组于麻醉诱导完成后输入纤维蛋白原剂量所需溶媒等容积的生理盐水。3组患者于给药前、后测定凝血4项及用凝血和血小板功能分析仪测定激活凝血时间（ACT）、凝血速率（CR）、血小板功能（PF），术毕称量出血量。结果FIB 在给药后 PF 组为（3．75±0．23）g／L，明显高于 NC 组（2．62±0．33）g／L 和 LC 组（2．23±0．22）g／L， 3组比较差异有统计学意义（P ＜0．05）；CR 值在给药后 PF 组为（21．42±7．15）U／min，高于 NC 组（18．21±5．62）U／min 和 LC组（15．21±5．63）U／min。PF 组出血量为（516．74±135．53）g，低于 NC 组（660．71±119．34）g 和 LC 组（726．72±160．47）g，3组比较差异有统计学意义（P ＜0．05）。结论术前 FIB 单次目标给药可以有效提高 FIB 水平及凝血功能，减少围术期出血量。