目标导向液体治疗对冠状动脉搭桥术后凝血-纤溶系统的影响OA

Objective To observe the effect of goal-directed fluid therapy(GDFT)on the coagulation-fi-brinolysis system in patients after coronary artery bypass grafting(CABG).Methods A prospective controlled clinical trial was conducted with 120 patients with coronary heart disease admitted to The First Affiliated Hospital of Henan University from August 2022 to March 2025.Patients were randomly divided into a con-ventional group and a GDFT group using a random number table,with 60 cases in each group.Both groups un-derwent off-pump CABG.During surgery,the conventional group received conventional fluid therapy,while the GDFT group received goal-directed fluid therapy.Perioperative hemodynamic parameters,volume load in-dicators,coagulation-fibrinolysis system function indices,and the incidence of complications were compared between the two groups.Results After treatment,the cardiac output and cardiac index in the GDFT group were significantly higher than those in the conventional group at intraoperative 1 h(T2)and at the end of sur-gery(T3),the differences were statistically significant(t=3.025,3.076,9.885,8.884,P<0.05).The left ven-tricular end-diastolic volume and left ventricular end-systolic volume in the GDFT group were lower than those in the conventional group at T2 and T3,the difference were statistically significant(t=2.645,3.762,3.021,2.971,P<0.05).Postoperative activated partial thromboplastin time,prothrombin time,and D-dimer in the GDFT group were(30.66±5.47)s,(13.23±3.29)s,and(0.36±0.19)mg/L,respectively,which were lower than those in the conventional group[(33.72±5.35)s,(15.29±3.62)s,(0.83±0.16)mg/L,respec-tively],while the fibrinogen level[(1.58±0.26)g/L]was higher than that in the conventional group[(0.94±0.19)g/L],the differences were statistically significant(t=3.098,3.262,14.657,15.395,P<0.05).By the end of follow-up,the complication rate[8.33%(5/60)]in the GDFT group was lower than 23.33%(14/60)in the conventional group,the difference was statistically significant(χ2=5.065,P=0.024).Conclusion GDFT can stabilize perioperative hemodynamics and cardiac volume load in patients undergoing off-pump CABG,and has positive effects on maintaining coagulation-fibrinolysis system function and reducing the risk of adverse prognosis.