Ucar Halil Ibrahim, Oc Mehmet, Tok Mustafa, Dogan Omer Faruk, Oc Bahar, Aydin Ahmet, Farsak Bora, Guvener Murat, Yorgancioglu Ali Cem, Dogan Riza, Demircin Metin, Pasaoglu Ilhan
Department of Cardiovascular Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Heart Surg Forum. 2007;10(5):E392-6. doi: 10.1532/HSF98.20071065.
Open heart surgery still involving major bleeding continues to be a major challenge after cardiac surgery and is also a significant cause of morbidity and mortality. Most hemostatic factors are intercorrelated with postoperative bleeding, and fibrinogen seems the most fundamental hemostatic risk factor for open heart surgery.
The study included 97 patients who underwent elective coronary artery surgery (78 men and 19 women; mean age, 60.9 +/- 10.3). Preoperative blood samples were obtained and preoprative quantitative determination of plasma fibrinogen levels were measured by the clotting method of Clauss using the fibrinogen kit. Patients were operated on by the same team and the same technique. The total amount of drainage blood from chest tubes was recorded after termination of operation.
There were statistical significance between the fibrinogen levels and the drainage (r = -0.897, P < .001). Chest drainage was a mean of 972 mL (range, 240-2445 mL) in the first 48 hours after sternotomy closure. Fibrinogen level and relation to age was statistically significant (P = .015). There was no statistical significance between fibrinogen levels and gender (male gender = 400.7 +/- 123.0 versus female gender = 395.6 +/- 148.1; P = .877) and between drainage and gender (male gender = 968.2 +/- 538.5 versus female gender = 990.0 +/- 554.7; P = .876). Two patients (2%) died early after the surgery. There were no significant differences between the postoperative bleeding and cardiopulmonary bypass time (P = .648) or cross-clamp time (P = .974).
The results of this study suggested that low preoperative fibrinogen level appears to be a useful diagnostic marker to assess the activity of the coagulation system, and that its preoperative level may serve as a potential risk factor for postoperative bleeding after coronary artery bypass surgery.
心脏直视手术仍存在大出血问题，这依然是心脏手术后的一项重大挑战，也是发病和死亡的重要原因。大多数止血因素与术后出血相互关联，而纤维蛋白原似乎是心脏直视手术最基本的止血风险因素。
该研究纳入了97例行择期冠状动脉手术的患者（78例男性和19例女性；平均年龄60.9±10.3岁）。术前采集血样，采用Clauss凝固法使用纤维蛋白原试剂盒对血浆纤维蛋白原水平进行术前定量测定。患者由同一团队采用相同技术进行手术。手术结束后记录胸腔引流管的总引流量。
纤维蛋白原水平与引流量之间存在统计学意义（r = -0.897，P <.001）。胸骨切开术关闭后最初48小时内胸腔引流量平均为972 mL（范围240 - 2445 mL）。纤维蛋白原水平与年龄的关系具有统计学意义（P =.015）。纤维蛋白原水平与性别之间无统计学意义（男性 = 400.7±123.0与女性 = 395.6±148.1；P =.877），引流量与性别之间也无统计学意义（男性 = 968.2±538.5与女性 = 990.0±554.7；P =.876）。两名患者（2%）术后早期死亡。术后出血与体外循环时间（P =.648）或主动脉阻断时间（P =.974）之间无显著差异。
本研究结果表明，术前纤维蛋白原水平低似乎是评估凝血系统活性的有用诊断标志物，其术前水平可能是冠状动脉搭桥术后出血的潜在风险因素。
