Changes and significance of peripheral blood myocardial enzymes, coagulation function and platelet parameters in patients with spleen rupture before and after operation
-
摘要: 目的:探讨脾脏破裂患者手术前后心肌酶谱、凝血及血小板参数的变化及意义。方法:收集2017年1月—2020年3月期间我院收治的69例创伤性脾破裂患者作为脾破裂组,按1∶1∶1比例收集同期收治的69例非脾破裂腹部外伤患者作为对照1组,同期69例健康体检者作为对照2组;脾破裂组、对照1组均于术前(T0)、术后6 h(T1)、术后1 d(T2)、术后3 d(T3)、术后1周(T4)、术后4周(T5)采集外周血,对照2组于体检当日采血,测定心肌酶谱、凝血功能及血小板参数,分析上述各项指标与脾脏破裂分级的关系。结果:脾破裂组T0~T4点肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)高于对照1组(P<0.05),脾破裂组、对照1组T0点CK、CK-MB、LDH均高于对照2组(P<0.05);脾破裂组、对照1组不同时间点纤维蛋白原(Fib)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、凝血因子Ⅶ活性(FⅦ:C)、凝血因子Ⅻ活性(FⅫ:C)比较存在组间、时间、交互效应(P<0.05);脾破裂组T0点Fib、FⅦ:C、FⅫ:C低于对照组2组,PT、TT较对照2组延长,APTT较对照2组缩短(P<0.05);与T0点比较,T2~T5点脾破裂组血小板计数(PLT)上升(P<0.05),对照1组T2~T5点PLT高于T0点(P<0.05),脾破裂组、对照1组T0点PLT低于对照2组(P<0.05);脾破裂组PLT升高至出现异常时间短于对照1组,PLT异常持续时间长于对照组1组(P<0.05),PLT峰值较对照组1组高,达峰值时间较对照1组短(P<0.05);脾脏破裂分级Ⅲ~Ⅳ级组T0~T5点CK、CK-MB、LDH高于Ⅰ~Ⅱ级组(P<0.05),T1~T5点Fib、FⅦ:C、FⅫ:C低于Ⅰ~Ⅱ级组(P<0.05),PT、TT长于Ⅰ~Ⅱ级组(P<0.05),APTT短于Ⅰ~Ⅱ级组(P<0.05),T3~T5点PLT高于Ⅰ~Ⅱ级组(P<0.05)。结论:脾破裂早期存在明显心肌损伤,脾切除术后血液处于不同程度高凝状态,PLT增多,且与脾破裂程度有关。脾切除术后需重视心肌酶谱、凝血及PLT监测,并针对性给予心肌保护及抗凝、抗血小板聚集药物干预,预防血栓相关并发症。Abstract: Objective: To investigate the changes and significance of myocardial enzymes, coagulation and platelet parameters in patients with spleen rupture before and after operation.Methods: This retrospective study enrolled 69 patients with traumatic spleen rupture(spleen rupture group), 69 patients with non-spleen rupture abdominal trauma(control group 1) and 69 normal healthy individuals(control group 2) from January 2017 to March 2020. Peripheral blood samples of the spleen rupture group and the control group were respectively collected before operation(T0), 6 h after operation(T1), 1 d after operation(T2), 3 d after operation(T3), 1 week after operation(T4), and 4 weeks after operation(T5), while those of the control group 2 were collected during physical examination. Changes in myocardial enzymes, coagulation function and platelet parameter were determined, and their relationship with spleen rupture classification was analyzed.Results: From T0 to T4, creatine kinase(CK), creatine kinase isoenzyme(CK-MB) and lactate dehydrogenase(LDH) in the spleen rupture group were higher than those in the control group 1(P<0.05). At T0, CK, CK-MB and LDH in the spleen rupture group and the control group 1 were higher than those in the control group 2(P<0.05). The comparison of fibrinogen(Fib), prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT), coagulation factor Ⅶ activity(FⅦ: C) and coagulation factor Ⅻ activity(FⅫ: C) in the spleen rupture group and the control group 1 showed inter-group, time and interaction effects(P<0.05). At T0, Fib, FⅦ: C and FⅫ: C in the spleen rupture group were lower than those in the control group 2, PT and TT were longer than those in the control group 2, and APTT was shorter than that in the control group 2(P<0.05). Compared with T0, platelet count(PLT) in the spleen rupture group and the control group 1 was higher from T2 to T5(P<0.05). At T0, PLT in the spleen rupture group and the control group 1 was lower than that in the control group 2(P<0.05). Compared with the control group 1, the spleen rupture group had shorter time for PLT increasing to abnormal level, longer duration of abnormal PLT, higher peak PLT, and shorter time to peak(P<0.05). Compared with the gradeⅠ~II group, the grade Ⅲ~Ⅳ group had higher CK, CK-MB and LDH from T0 to T5, lower Fib, FⅦ: C and FⅫ: C from T1 to T5, longer PT and TT and shorter APTT, and higher PLT from T3 to T5(P<0.05).Conclusion: There was obvious myocardial injury in the early stage of spleen rupture. The patients' blood was in hypercoagulable states of varying degrees, and PLT increased after splenectomy, which was related to the degree of spleen rupture. Therefore, it is necessary to pay attention to monitoring myocardial enzymes, blood coagulation and PLT after splenectomy and carry out targeted intervention with cardioprotective, anticoagulant and antiplatelet drugs to prevent thrombus-related complications.
-
Key words:
- abdominal trauma /
- spleen rupture /
- myocardial enzymes /
- coagulation /
- platelet /
- thrombus
-
-
[1] Siliézar MM,Muňoz CC,Solano-Iturri JD,et al.Spontaneously Ruptured Spleen Samples in Patients With Infectious Mononucleosis:Analysis of Histology and Lymphoid Subpopulations[J].Am J Clin Pathol,2018,150(4):310-317.
[2] 李后俊,周正武,刘晓林.手术治疗与保守治疗创伤性脾破裂的临床效果比较[J].临床外科杂志,2019,27(11):992-994.
[3] Autry JR,Weitzner S.Hemangiosarcoma of spleen with spontaneous rupture.[J].Cancer,2015,35(2):534-539.
[4] Topcu AC,Ciloglu U,Bolukcu A,et al.Management of Traumatic Aortic and Splenic Rupture in a Patient With Ascending Aortic Aneurysm[J].Ann Thorac Surg,2016,102(2):e81-82.
[5] 任琴,杨晓曦.创伤性脾破裂患者不同病情及不同时间外周血肌酸激酶的变化[J].湖南师范大学学报(医学版),2017,14(4):55-58.
[6] Radwan I,Magdy Khattab M,Mahmoud AR,et al.Systematic review of spontaneous splenic rupture in dengue-infected patients[J].Rev Med Virol,2019,29(2):e2029.
[7] 钟平勇,王杰,牟廷刚,等.预防性抗凝治疗对腹腔镜脾切除联合贲门周围血管离断术后门静脉血栓形成的效果[J].中华普通外科杂志,2020,35(4):281-283.
[8] 中华医学会外科学分会脾功能与脾脏外科学组.脾脏损伤治疗方式的专家共识(2014版)[J].临床肝胆病杂志,2015,31(7):1002-1003.
[9] 蒋妍,李婧,宋维平,等.部分脾栓塞术与脾切除术治疗肝硬化并发脾功能亢进的疗效比较[J].同济大学学报(医学版),2019,40(6):872-876.
[10] 沈良云.外伤性脾破裂脾切除术后血小板增多合并假性高钾血症1例[J].实用临床医药杂志,2018,22(22):110.
[11] 马娜娜,肖明,刘跃森.脾切除后突发急性心肌梗死1例[J].岭南心血管病杂志,2016,22(2):215-217.
[12] 田轶魁.脾脏介导的免疫炎症反应参与小鼠心肌缺血再灌注损伤的实验研究[D].天津:天津医科大学,2016.
[13] 李永双.创伤性脾破裂患者早期外周血肌酸激酶及其同工酶的变化及临床意义[J].中国综合临床,2015,31(1):75-78.
[14] 周正武,韩圣瑾,郑学海,等.脾切除术后心肌酶变化的临床分析[J].中国现代普通外科进展,2015,18(3):245-246.
[15] 杨俊生,包永进,陈卫波,等.精准外科理念下的腹腔镜脾部分切除术[J].中华普通外科杂志,2020,35(3):219-222.
[16] 李志州,向俊峰,周威,等.探讨门脉高压及外伤性脾破裂行脾切除术后血小板升高及门静脉血栓形成情况[J].肝胆外科杂志,2018,26(4):280-282.
[17] 潘月,杨小莉,李罗红,等.肝硬变门静脉高压症患者脾切除术后血小板变化及其临床意义[J].实用医院临床杂志,2019,16(4):16-18.
[18] 张涛,范顺利,吕少诚,等.不同病因行脾切除术后血小板变化趋势探讨[J].解放军医学院学报,2018,39(1):13-15.
[19] 韩涛,张树顺,郭亚民,等.脾切除联合脾片移植治疗Ⅲ-Ⅳ级脾破裂的疗效及对免疫功能和血栓形成风险的影响评估[J].临床外科杂志,2018,26(12):943-945.
[20] 蒋安,李宗芳.腹腔镜脾切除贲门周围血管断流术围手术期凝血功能的两段式调整策略[J].腹腔镜外科杂志,2017,22(8):577-578.
-
计量
- 文章访问数: 206
- PDF下载数: 104
- 施引文献: 0
下载: