Sharrock N E, Go G, Sculco T P, Ranawat C S, Maynard M J, Harpel P C
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA.
J Arthroplasty. 1995 Aug;10(4):523-8. doi: 10.1016/s0883-5403(05)80155-x.
Deep vein thrombosis may begin during surgery with the tourniquet inflated. Arterial levels of fibrinopeptide A, thrombin-antithrombin complexes, D-dimer, tissue plasminogen activator (t-PA) activity, and t-PA antigen were measured before surgery, during surgery with the tourniquet inflated, and following deflation of the tourniquet in 12 patients undergoing total knee arthroplasty. Minimal increases in fibrinopeptide A, thrombin-antithrombin complexes, and D-dimer were noted during surgery with the tourniquet inflated, but significant increases occurred immediately following deflation of the tourniquet. In 10 patients, intravenous heparin administration significantly suppressed the rise in fibrinopeptide A, but did not significantly alter the increases in either thrombin-antithrombin complexes, D-dimer, t-PA antigen, or t-PA activity. This study provides further evidence that deep vein thrombosis begins during surgery.
深静脉血栓形成可能在手术过程中止血带充气时开始。对12例行全膝关节置换术的患者，在手术前、止血带充气时以及止血带放气后，测定了动脉血中纤维蛋白肽A、凝血酶 - 抗凝血酶复合物、D - 二聚体、组织型纤溶酶原激活物（t - PA）活性和t - PA抗原的水平。在止血带充气的手术过程中，纤维蛋白肽A、凝血酶 - 抗凝血酶复合物和D - 二聚体仅有轻微升高，但在止血带放气后立即出现显著升高。在10例患者中，静脉注射肝素可显著抑制纤维蛋白肽A的升高，但对凝血酶 - 抗凝血酶复合物、D - 二聚体、t - PA抗原或t - PA活性的升高没有显著影响。这项研究进一步证明深静脉血栓形成始于手术过程中。
