Grant P J, Hampton K K, Primrose J, Davies J A, Prentice C R
University Department of Medicine, General Infirmary, Leeds, UK.
Blood Coagul Fibrinolysis. 1991 Oct;2(5):647-50. doi: 10.1097/00001721-199110000-00010.
Major abdominal surgery is accompanied by intra-operative increases in factor VIII (FVIII), plasminogen activator activity (PAA) and fibrinopeptide A (FPA). Vasopressin (aVP) released during surgery mediates some of the effects but the mechanisms involved in this response are unclear. To investigate the role of the operative procedure, 20 subjects were studied during inguinal hernia operation under local anaesthesia. Venous blood samples were taken for FVIII coagulant activity (FVIII:C), euglobulin clot lysis time (ECLT), FPA, crosslinked FDPs (XL-FDP) and a VP. In six patients, aVP rose from (median) 0.5 to 38.3 pg/ml at bowel manipulation and fell to 4.1 pg/ml post-operatively. PAA rose from 33 units to 377 and 316 units (P less than 0.01), FVIII:C from 1.58 to 2.4 IU/ml (P less than 0.01) and FPA from 5.0 to 6.8 and 11.0 pmol/ml intra-operatively (P less than 0.002). XL-FDP rose from a median value of 34 ng/ml pre-operatively to 230 ng/ml post-operatively. In 14 patients plasma aVP levels remained constant and both FVIII:C and PAA remained unchanged. FPA rose from 2.6 pmol/ml to 5.9 pmol/ml intra-operatively (P less than 0.05) and XL-FDP fell from 110 to 60 ng/ml. Between groups, the changes were significantly different for FVIII:C (P less than 0.05) and PAA (P less than 0.03) with no differences in blood pressure, pulse or symptoms. These results support the hypothesis that aVP secretion during surgery mediates increases in FVIII and PAA. FPA tended to be higher in the aVP secreting group which indicates that aVP mediated activation of coagulation results in a hypercoagulable state.
腹部大手术伴随着术中凝血因子 VIII（FVIII）、纤溶酶原激活物活性（PAA）和纤维蛋白肽 A（FPA）的升高。手术过程中释放的血管加压素（aVP）介导了部分效应，但这种反应所涉及的机制尚不清楚。为了研究手术操作的作用，对 20 名在局部麻醉下进行腹股沟疝手术的受试者进行了研究。采集静脉血样本检测 FVIII 凝血活性（FVIII:C）、优球蛋白凝块溶解时间（ECLT）、FPA、交联纤维蛋白降解产物（XL-FDP）和 aVP。在 6 名患者中，肠道操作时 aVP 从（中位数）0.5 上升至 38.3 pg/ml，术后降至 4.1 pg/ml。术中 PAA 从 33 单位升至 377 和 316 单位（P＜0.01），FVIII:C 从 1.58 升至 2.4 IU/ml（P＜0.01），FPA 从 5.0 升至 6.8 和 11.0 pmol/ml（P＜0.002）。XL-FDP 从术前中位数 34 ng/ml 升至术后 230 ng/ml。在 14 名患者中，血浆 aVP 水平保持恒定，FVIII:C 和 PAA 均未改变。术中 FPA 从 2.6 pmol/ml 升至 5.9 pmol/ml（P＜0.05），XL-FDP 从 110 降至 60 ng/ml。两组之间，FVIII:C（P＜0.05）和 PAA（P＜0.03）的变化有显著差异，血压、脉搏或症状无差异。这些结果支持了手术期间 aVP 分泌介导 FVIII 和 PAA 升高的假说。aVP 分泌组的 FPA 往往更高，这表明 aVP 介导的凝血激活导致高凝状态。
