开胸手术与电视辅助胸腔镜手术患者术后高凝全血特征。
Post-operative hypercoagulable whole blood profiles in patients undergoing open thoracotomy vs video-assisted thoracoscopic surgery.
机构信息
Haemorrhagic and Thrombotic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy.
Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy.
出版信息
Blood Transfus. 2021 Mar;19(2):144-151. doi: 10.2450/2020.0040-20. Epub 2020 Aug 6.
BACKGROUND
Patients undergoing video-assisted thoracoscopic surgery (VATS) have a lower risk of thrombosis compared to those undergoing open thoracotomy (OT) which may be due to several post-operative factors such as early mobilisation, shorter hospital stays, lower transfusion rates and lower risk of infections. Whether the higher thrombotic risk after OT is also linked to a peri-operative hypercoagulable state is a matter of debate. We therefore conducted a case-control study to compare peri-operative coagulation profiles in patients with primary lung cancer undergoing VATS vs OT.
MATERIALS AND METHODS
All consecutive patients undergoing VATS or OT for primary lung cancer at the Department of Thoracic Surgery of Padua University Hospital, Italy, between February and June 2018 were enrolled. Each patient provided a venous blood sample at least 30 min prior to surgical incision (T0) and 4±1 days after surgery (T1). Peri-operative coagulation profiles were assessed via traditional, viscoelastic whole blood (ROTEM [Instrumentation Laboratory-Werfen]) and impedance aggregometry (Multiplate Analyser [Roche Diagnostics]) tests.
RESULTS
We enrolled 65 patients (males 43, females 22; mean age 65±13 years) of whom 35 (54%) underwent VATS and 30 (46%) underwent OT. Compared to healthy controls, the surgical group (VATS and OT patients) had a significantly shorter clot formation time and higher alpha angle and maximum clot firmness values, as well as increased mean platelet function. In the post-operative period, patients who underwent OT had a significantly shorter clot formation time, higher alpha angle and maximum clot firmness values and higher mean platelet function vs VATS patients.
DISCUSSION
Whole blood ROTEM profiles and Multiplate aggregometry identified a more hypercoagulable post-operative state in patients who underwent OT than in those who underwent VATS. Larger studies are warranted to confirm our results and ascertain whether the observed hypercoagulability might promote post-operative thrombosis.
背景
与开胸手术（OT）相比，接受电视辅助胸腔镜手术（VATS）的患者血栓形成的风险较低，这可能是由于术后的一些因素，如早期活动、住院时间缩短、输血率降低和感染风险降低。OT 后较高的血栓形成风险是否也与围手术期高凝状态有关，这是一个有争议的问题。因此，我们进行了一项病例对照研究，比较了原发性肺癌患者接受 VATS 与 OT 时的围手术期凝血谱。
材料和方法
2018 年 2 月至 6 月，意大利帕多瓦大学医院胸外科连续收治接受 VATS 或 OT 治疗的原发性肺癌患者。每位患者在手术切口前至少 30 分钟（T0）和术后 4±1 天（T1）时提供一份静脉血样本。通过传统的、粘弹性全血（ROTEM[Instrumentation Laboratory-Werfen]）和阻抗聚集仪（Multiplate Analyser[Roche Diagnostics]）检测围手术期凝血谱。
结果
我们共纳入 65 例患者（男性 43 例，女性 22 例；平均年龄 65±13 岁），其中 35 例（54%）接受了 VATS，30 例（46%）接受了 OT。与健康对照组相比，手术组（VATS 和 OT 患者）的凝血形成时间更短，α角和最大凝血硬度值更高，血小板平均功能增加。术后，接受 OT 的患者凝血形成时间更短，α角和最大凝血硬度值更高，血小板平均功能高于接受 VATS 的患者。
讨论
全血 ROTEM 谱和 Multiplate 聚集仪检测到，接受 OT 的患者比接受 VATS 的患者术后有更高的高凝状态。需要更大的研究来证实我们的结果，并确定观察到的高凝状态是否会促进术后血栓形成。
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