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目的探讨前列腺增生(BPH)患者经尿道等离子体双极电切术(PKRP)围手术期血小板、凝血系统、纤溶系统和下肢深静脉血流速度的变化及其在围手术期血栓前状态中的诊断意义。方法选取我院行PKRP的BPH患者50例作为研究对象(PKRP组),同期入院非手术治疗男性患者50例作为对照组,应用全自动血液黏度动态分析仪、酶联免疫吸附方法和发色底物法测定患者血小板计数(Plt)、血小板聚集指数(PAg)、血小板黏附指数(PAd)、血管性血友病因子(vWF)、凝血酶原片段1+2(F1+2)、凝血酶-抗凝血酶复合物(TAT)、纤维蛋白原(Fbg)、抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物(PAI-1)、D-二聚体(D-D);同时用彩色多普勒超声检测患者下肢深静脉(腘静脉、股静脉)的血流速度(Vpop、Vfem)。结果 BPH患者术后Pag、PAd、vWF、F1+2、TAT、D-D升高,AT-Ⅲ、PC降低,Plt、Fbg、PAI-1先降低后升高,t-PA先升高后降低,差异均有统计学意义(P<0.05);术后Vpop、Vfem降低,差异具有统计学意义(P<0.05)。结论 BPH患者PKRP围手术期血小板黏附、聚集功能增强,凝血功能增强,抗凝及纤溶功能减弱,下肢血流速度减慢,处于明显的血栓前状态。
Objective To investigate the changes of perioperative blood platelets, coagulation system, fibrinolytic system and deep venous blood flow in patients with benign prostatic hyperplasia (BPH) undergoing transurethral plasma-bipolar nephrectomy (PKRP) and its effect on perioperative prothrombotic state The diagnostic significance. Methods Fifty patients with PKH in our hospital were enrolled as the study group (PKRP group). Fifty non-surgical male patients were enrolled in the same period as the control group. The patients were divided into two groups according to the dynamic blood viscosity analyzer, enzyme-linked immunosorbent assay The platelet count, platelet aggregation index (PAg), platelet adhesion index (PAd), vWF, prothrombin fragment 1 + 2 (F1 + 2), thrombin- TAT, Fbg, AT-III, PC (C), tissue plasminogen activator (t-PA), fibrin (PAI-1) and D-dimer (DD). The blood flow velocity (Vpop, Vfem) of deep venous (veins, femoral vein) . Results The levels of Pag, PAd, vWF, F1 + 2, TAT and DD were increased, the AT-Ⅲ and PC were decreased, the levels of Plt, Fbg and PAI-1 were decreased first and then increased, while t- (P <0.05). Vpop and Vfem decreased after operation, the difference was statistically significant (P <0.05). Conclusion Peripheral blood platelet adhesion, aggregation, blood coagulation, anticoagulant and fibrinolysis in PKH patients with BPH are weakened, blood flow velocity of the lower extremities is slowed down, and it is obviously prethrombotic state.