Kessler Ulf, Guenther Patrick, Zachariou Zacharias
Department of Surgical Pediatrics, Inselspital, Bern, Switzerland.
Clin Hemorheol Microcirc. 2006;34(3):447-52.
First to assess coagulation changes after surgery in children below 6 months of age. Second to detect differences attributable to the extent of surgery and postoperative infection.
Blood counts, haemoglobin concentration (Hb), haematocrit (Ht), prothrombine time (PT), activated partial thromboplastine time (aPTT) and thrombelastography (TEG) were studied pre- and 2+/-1/2 d postoperatively. Patients were divided in 3 groups. I: minor surgery without access to the abdomen or thorax (n=51); II: abdominal or thoracic interventions (n=24); III: abdominal surgery with postoperative sepsis (n=11).
Preoperative values of Hb, Ht and INR were related to the age of the infant. Postoperatively clot strength and formation rate increased in gr. I (p<0.05). In gr. II, clot formation was initiated earlier (p<0.05) even though PT decreased (p<0.05). In group III, patients postoperatively developed a tendency for hypocoagulability in all TEG-parameters, but not in plasmatic coagulation. Postoperative TEG measurements were significantly inferior in gr. III when compared to gr. I and II.
Our findings suggest activation of whole blood coagulation in the uncomplicated postoperative period despite of a decrease in plasmatic coagulation. In sepsis, only thrombelastography, but not plasmatic coagulation was affected.
首先评估6个月以下儿童术后的凝血变化。其次检测因手术范围和术后感染导致的差异。
在术前及术后2±1/2天研究血细胞计数、血红蛋白浓度（Hb）、血细胞比容（Ht）、凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和血栓弹力图（TEG）。患者分为3组。I组：不涉及腹部或胸部的小手术（n = 51）；II组：腹部或胸部手术（n = 24）；III组：腹部手术伴术后脓毒症（n = 11）。
Hb、Ht和国际标准化比值（INR）的术前值与婴儿年龄相关。术后I组的血凝块强度和形成率增加（p < 0.05）。在II组中，尽管PT降低（p < 0.05），但血凝块形成更早开始（p < 0.05）。在III组中，患者术后所有TEG参数均出现低凝倾向，但血浆凝血方面未出现。与I组和II组相比，III组术后TEG测量结果明显较差。
我们的研究结果表明，尽管血浆凝血功能下降，但在术后无并发症期间全血凝血被激活。在脓毒症中，仅血栓弹力图受到影响，而血浆凝血未受影响。
