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[根据治疗方法不同,胃肠道出血患者止血指标的变化]

[Changes in hemostasis indices in patients with gastrointestinal hemorrhages depending on treatment methods].

作者信息

Fedorova N V, Matveev S B, Syromiatnikova E D, Lebedev A G

出版信息

Khirurgiia (Mosk). 1991 May(5):75-8.

PMID:1906560
Abstract

The dynamics of changes in some values of the hemostatic system was studied on days 1, 3, and 7 after gastrointestinal hemorrhage (GIH) of ulcerous etiology during enteral (administration of an electrolyte-monomer solution through a tube) and parenteral (traditional administration of infusion solutions) treatment. In operated on patients with enteral correction marked hyperfibrinogenemia was revealed, as well as diminished blood fibrinolytic activity, prolonged thrombin time, and a positive ethanol test, which indicates the predominance of hypercoagulation changes in the blood. Patients who were not subjected to operation but were given enteral correction had marked thrombocytopenia, reduced tolerance of plasma to heparin in all test periods tendency towards reduction of the fibrinogen content during the whole week after the hemorrhage in normal values of fibrinolytic activity, positive ethanol and protamine sulfate tests, which is evidence of hypocoagulation shifts in the hemostatic system. Reduction of the 4th thrombocytic factor, a tendency towards diminution of plasma tolerance to heparin, normal fibrinogen level, reduced blood fibrinolytic activity, and negative ethanol and protamine sulfate tests were revealed in patients who did not undergo operation and were given the traditional parenteral treatment, which reflects the compensatory character of the blood coagulation system response to rapidly developing blood loss. Disorders of the hemostatic system were more marked in patients with GIH who were not operated on and were given enteral correction, who require additional therapy.

摘要

在因溃疡病因导致胃肠道出血(GIH)后的第1天、第3天和第7天,对肠内(通过管道给予电解质 - 单体溶液)和肠外(传统给予输液溶液)治疗期间止血系统某些值的变化动态进行了研究。在接受肠内纠正的手术患者中,发现有明显的高纤维蛋白原血症,以及血液纤溶活性降低、凝血酶时间延长和乙醇试验阳性,这表明血液中高凝状态变化占主导。未接受手术但接受肠内纠正的患者出现明显的血小板减少,在所有测试期间血浆对肝素的耐受性降低,在出血后整周内纤维蛋白原含量有降低趋势,纤溶活性在正常范围内,乙醇和硫酸鱼精蛋白试验阳性,这是止血系统中低凝状态转变的证据。未接受手术且接受传统肠外治疗的患者中,发现第4血小板因子降低,血浆对肝素的耐受性有降低趋势,纤维蛋白原水平正常,血液纤溶活性降低,乙醇和硫酸鱼精蛋白试验阴性,这反映了凝血系统对快速发生的失血反应的代偿性特征。未接受手术且接受肠内纠正的GIH患者的止血系统紊乱更为明显,这些患者需要额外治疗。

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