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目的 观察前列腺切除病人围术期凝血纤溶功能的动态变化，为指导临床合理使用抗凝止血类药物提供理论依据。方法 全组病人３６ 例，分为三组，Ⅰ组（对照组）：泌尿系结石切开取石组，Ⅱ组：前列腺增生手术摘除组，Ⅲ组：经尿道前列腺电切（ＴＵＲＰ）组，定时抽血作凝血及纤溶功能有关指标检测。结果 （１）Ⅱ、Ⅲ组病人术中及术后早期Ｆ．Ⅱａ、ｔＰＡ、ＰＬＭ 活性均增强，而ＡＴ－Ⅲ、α２－ＰＩ活性下降；（２）Ⅱ、Ⅲ组病人术后Ｆｂｇ 含量增多，ＡＴ－Ⅲ活性降低，机体处于高凝状态，以及ＰＡＩ活性增强导致的纤溶抑制功能增强，表明机体凝血纤溶功能失衡，有利于血栓形成；（３）Ⅱ、Ⅲ组病人Ｄ－二聚体含量术中及术后均明显升高。结论 前列腺切除病人术中、术后均处于高凝状态，有利于血栓形成；ｔＰＡ释放增多导致的原发性纤溶亢进可能是前列腺术中及术后出血的主要原因，但同时不能排除继发性纤溶存在的可能性。提示适量使用抗纤溶类止血药可能较凝血酶类止血药更为恰当。
Objective To observe the dynamic changes of perioperative coagulation and fibrinolytic function in patients undergoing prostatectomy, and to provide a theoretical basis for guiding clinical rational use of anticoagulant and hemostatic drugs. Methods Thirty-six patients were divided into three groups: group Ⅰ (control group): urolitholithotomy group Ⅱ group: benign prostatic hyperplasia group, group Ⅲ: transurethral resection of prostate (TURP) group, Blood for coagulation and fibrinolysis related indicators test. Results (1) Ⅱ, Ⅲ group of patients during surgery and early postoperative F Ⅱa, tPA and PLM activity increased, while the activity of AT-Ⅲ and α2-PI decreased. (2) The levels of Fbg, AT-Ⅲ activity decreased, body hypercoagulability and PAI activity increased in group Ⅱ and Ⅲ Resulting in increased inhibition of fibrinolysis, indicating that the body coagulation and fibrinolysis imbalance is conducive to thrombosis; (3) Ⅱ, Ⅲ group of patients D-dimer levels were significantly increased intraoperative and postoperative. Conclusions Prostatectomy patients underwent hypercoagulable intraoperative and postoperative hyperparathyroidism, which is propitious to thrombosis. The primary hyperfibrinolysis induced by increased tPA release may be the main reason for postoperative prostatectomy and postoperative bleeding, but at the same time can not rule out secondary The possibility of sexual fibrinolysis. Tip appropriate amount of fibrinolytic hemostatic may be more appropriate than the thrombin-type hemostatic.