Mutoh S, Teh A, Shimoji Y, Nishi N, Saitoh M, Maki M
Nihon Sanka Fujinka Gakkai Zasshi. 1985 Oct;37(10):2049-58.
In our previous study, we reported that pregnant blood was hypercoagulable and hypo-fibrinolytic. However, localized fibrinolytic activity, e.g. in the placenta, seemed to be present, because of increased FDP and fibrinopeptide B beta 15-42 during pregnancy. In this study, we tried to find out the changes in the coagulation-fibrinolysis system as well as cold insoluble globulin when stress such as operative procedure is being added. In 25 cases of cesarean section in full term pregnancy without onset of labor, blood samples were collected before operation, during operation and 3 hours, 6 hours, 12 hours, 24 hours and 48 hours post-operatively for estimation of the coagulation factors (FXII, IX, VIII, VII, X, V, II. XIII. Fbg), fibrinolytic factors (plg-Act, plg, SFMC, FDP), prekallikrein, plasma serin protease inhibitors (AT-III, alpha 2-PI, alpha 2-M, alpha 1-AT) and cold insoluble globulin. 30 normal term-pregnant women as well as 30 non-pregnant women were studied as the control. The result showed that the activities of both the intrinsic and extrinsic coagulation factors were markedly increased while the Fbg and AT-III were markedly decreased from during operation to 3 hours after operation. FXIII was markedly decreased and FII was slightly decreased from during operation. The marked decreases in prekallikrein, plg, alpha 2-PI, alpha 2-M, alpha 1-AT together and marked increases in plg-Act and FDP were noted from 3 to 12 hours after operation. A marked decrease in CIG was demonstrated immediately after the operation and continued until 48 hours after operation. These findings suggested that hypercoagulable state and secondary hyperfibrinolysis were associated during and after cesarean section. Decreases in Factor XIII and CIG seemed to be a general reaction in the mechanism of wound healing.
在我们之前的研究中，我们报道了孕妇血液呈高凝状态且纤维蛋白溶解功能减退。然而，由于孕期纤维蛋白降解产物（FDP）和纤维蛋白肽Bβ15 - 42增加，似乎存在局部纤维蛋白溶解活性，例如在胎盘。在本研究中，我们试图找出当增加诸如手术操作等应激因素时，凝血 - 纤溶系统以及冷不溶性球蛋白的变化。选取25例足月未临产行剖宫产的孕妇，于术前、术中及术后3小时、6小时、12小时、24小时和48小时采集血样，以测定凝血因子（FXII、IX、VIII、VII、X、V、II、XIII、纤维蛋白原）、纤溶因子（纤溶酶原激活物、纤溶酶原、可溶性纤维蛋白单体复合物、FDP）、前激肽释放酶、血浆丝氨酸蛋白酶抑制剂（抗凝血酶III、α2 - 纤溶酶抑制物、α2 - 巨球蛋白、α1 - 抗胰蛋白酶）和冷不溶性球蛋白。选取30例足月孕妇及30例非孕妇作为对照。结果显示，从术中到术后3小时，内源性和外源性凝血因子的活性均显著增加，而纤维蛋白原和抗凝血酶III显著降低。从术中开始，FXIII显著降低，FII略有降低。术后3至12小时，前激肽释放酶、纤溶酶原、α2 - 纤溶酶抑制物、α2 - 巨球蛋白、α1 - 抗胰蛋白酶共同显著降低，纤溶酶原激活物和FDP显著增加。术后立即显示冷不溶性球蛋白显著降低，并持续至术后48小时。这些发现提示剖宫产术中及术后存在高凝状态和继发性高纤维蛋白溶解。XIII因子和冷不溶性球蛋白的降低似乎是伤口愈合机制中的一种普遍反应。
