目的 观察体外循环心脏停搏与不停搏心内直视手术对机体凝血功能的影响.方法 50例体外循环心内手术患者随机分成心脏停搏(AH)组25例、心脏不停搏(BH)组25例,对比两组患者切皮前即刻(T1)、给予鱼精蛋白10 min后(T2)、关胸即刻(T3)、术后4 h(T4)血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)含量、血小板计数(PLT)、血浆游离Ca2+、活化凝血酶原时间(ACT)等指标的变化,并记录术后24 h胸腔引流量和术中、术后24h库血的用量等临床情况.结果 PT、APTT、TT、FIB、D-D、PLT计数、血浆游离Ca2+、ACT在各时间点测定值两组间比较差异均无统计学意义(P＞0.05);库血用量BH组比AH组明显减少(P＜0.05);术后24 h胸腔引流量两组比较差异无统计学意义(P＞0.05).结论 与低温心脏停搏心内直视手术体外循环比较,浅低温心脏不停搏心内手术体外循环不加重凝血功能紊乱,能保护血小板功能,减少异体输血量.%Objective To compare the effects of arresting-heart surgery and beating-heart surgery during cardiopulmonary bypass( CPB )on patients′ blood coagulation. Methods 50 patients with heart disease were divided into beating-heart surgery group( n = 25 )and arresting-heart surgery group( n = 25 ). The changes of prothrombin time ( PT ),activated partial thromboplastin time( APTT ), thrombin time( TT ), fibrinogen( FIB ), D-dimer( D-D )levels,platelet count( PLT ), plasma free Ca2 + , activated prothrombin time( ACT )before skin incision( T1 ), 10 minutes after heparin neutralization by protamine( T2 )and closed chest( T3 )3 -5 hours after operation( T4 )were detected, the amount of postoperative thoracic drainage at 24 hours and homologous blood during and after operation were recorded.Results The values of PT,APTT,TT,FIB,D-D,PLT count,plasma free Ca2+ and ACT at each time point were not statistically significant between the two groups( P ＞ 0.05 ). The amount of homologous blood beating-heart surgery group was significantly less than that of arresting-heart surgery group( P ＜ 0.05 ). The amount of postoperative thoracic drainage at 24 hours was not statistically significant between the two groups( P ＞ 0.05 ). Conclusion Compared with hypothemfic arresting-heart surgery, mild hypothemfia beating-heart after cardiopulmonary bypass does not increase blood clotting disorder. Mild hypothermia beating-heart in open heart surgery with cardiopulmonary bypass can be obviously protected platelet and reduced blood using.
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