Páramo J A, Rifón J, Llorens R, Casares J, Paloma M J, Rocha E
Hematology Service, University of Navarra, Pamplona, Spain.
Haemostasis. 1991;21(1):58-64. doi: 10.1159/000216203.
The influence of cardiopulmonary bypass (CPB) on fibrinolytic activity was assessed in 100 patients with valvular heart disease or atrial septal defects. Euglobulin fibrinolytic activity (EFA), tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor 1 (PAI-1) activity, plasminogen, alpha 2-antiplasmin (alpha 2-AP), fibrinogen degradation products (FDP), and D-dimer were measured pre-, intra-, and postoperatively. There were significant increases in EFA and t-PA activity (p less than 0.002), and decreases in plasminogen and alpha 2-AP (p less than 0.0001) intraoperatively with respect to baseline values. t-PA activity decreased significantly after surgery (p less than 0.002), whereas PAI-1 activity showed a marked increase shortly after operation and on postoperative day 1 (p less than 0.0001). FDP and D-dimer levels were significantly increased both intra- and postoperatively, the latter showing higher values (p less than 0.01 and p less than 0.0001, respectively). This study shows that there is an activation of the fibrinolytic system, as a result of the increased activation of plasminogen and decreased levels of plasmin inhibitors, during CPB surgery followed by a postoperative fibrinolytic shutdown.
在100例瓣膜性心脏病或房间隔缺损患者中评估了体外循环（CPB）对纤溶活性的影响。测定了术前、术中及术后的优球蛋白纤溶活性（EFA）、组织型纤溶酶原激活物（t-PA）活性、纤溶酶原激活物抑制剂1（PAI-1）活性、纤溶酶原、α2-抗纤溶酶（α2-AP）、纤维蛋白原降解产物（FDP）和D-二聚体。术中与基线值相比，EFA和t-PA活性显著增加（p<0.002），纤溶酶原和α2-AP降低（p<0.0001）。术后t-PA活性显著降低（p<0.002），而PAI-1活性在术后不久及术后第1天显著升高（p<0.0001）。术中及术后FDP和D-二聚体水平均显著升高，后者升高更明显（分别为p<0.01和p<0.0001）。本研究表明，在CPB手术期间，由于纤溶酶原激活增加和纤溶酶抑制剂水平降低，纤溶系统被激活，随后出现术后纤溶关闭。
