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目的探讨两种抗凝方案下,房间隔缺损(atrial septal defect,ASD)封堵术后纤溶功能的变化规律及其意义。方法 85例成功进行封堵术治疗的ASD患者随机分为延长低分子肝素(prolong low molecular weight heparin,pLWMH)组及低分子肝素(LWMH)组,采用酶联免疫吸附法测定封堵术前、术后即刻、术后第1、2、3、7天及术后第1、3个月血浆组织型纤维溶酶原激活物(tissue plasminogen activator,tPA)、D-D二聚体(D-Dimer)水平。结果封堵术前pLWMH组和LWMH组tPA、D-Dimer无明显差异;术后即刻两组tPA、D-Dimer均较术前明显增加并均达峰值(P<0.05);术后第1、2天两组tPA、D-Dimer均逐渐下降,仍较术前增加;术后第3天两组tPA、D-Dimer均接近术前水平,pLWMH组高于LWMH组,差异无统计学意义。结论无论低分子肝素组还是延长低分子肝素组,ASD封堵术后纤溶功能一过性激活,至术后3 d恢复术前水平。
Objective To investigate the changes and significance of fibrinolytic function after atrial septal defect (ASD) occlusion in two kinds of anticoagulation protocols. Methods Eighty-five ASD patients successfully treated with occlusion were randomly divided into prolong low molecular weight heparin (pLWMH) group and low molecular weight heparin (LWMH) group. Enzyme-linked immunosorbent assay (ELISA) Immediately after operation, the plasma level of tissue plasminogen activator (tPA), DD dimer (D-dimer) at 1, 2, 3, 7 days and 1, Level. Results There was no significant difference in tPA and D-Dimer between pre-closure and pre-operative LWMH group. The levels of tPA and D-Dimer in postoperative immediately after operation were significantly increased and reached the peak values (P <0.05) The levels of tPA and D-Dimer in both groups decreased gradually at 2 days and still increased compared with that before operation. The levels of tPA and D-Dimer in both groups were close to the preoperative levels on the third day after operation, while the levels in pLWMH group were higher than those in LWMH group. There was no significant difference between the two groups. Conclusions Whether low molecular weight heparin group or low molecular weight heparin group is prolonged, the fibrinolytic function of ASD is transiently activated and restored to preoperative level on the 3rd day after operation.