中文摘要：

目的：揭示接受低温停循环下弓部替换手术的急性Stanford A型主动脉夹层患者围手术期内源性凝血物质的变化情况,寻找纠正围手术期凝血功能障碍的新靶点。方法：收集2013年01月至2015年09月,在北京安贞医院经主动脉造影（CTA）确诊急性Stanford A型主动脉夹层,并接受低温停循环手术的88例患者的血液样本,分别在术前至术后5个标志性时间点,检测具有代表性的内源性凝血物质（凝血因子Ⅻ及Ⅻa,内源性凝血刺激因子前激肽释放酶,缓激肽,高分子激肽原,组蛋白-DNA复合物）的水平,并与外源性凝血物质（凝血因子Ⅶ,凝血因子Ⅶa）的变化规律进行比较。结果：与凝血因子Ⅶ相比,凝血因子Ⅻ从TI~T2表现出更为显著的下降趋势（凝血因子Ⅻ从T1~T2的下降趋势为42%,凝血因子Ⅶ从T1~T2的下降趋势为20%,P〈0.001）。凝血因子Ⅶ在T4基本恢复至T1水平（P〈0.001）,而凝血因子Ⅻ在T4时的水平仍未恢复至T1水平（P=0.01）。缓激肽术前水平即显著高于正常,在术中低温停循环过程中降至最低,随后逐渐升高至术前水平以上,术后4h到达顶峰;其他刺激因子在术前至术后24h,5个时间点则无明显变化趋势（P〉0.05）。结论：与凝血因子Ⅶ相比,凝血因子Ⅻ在低温停循环手术中受抑制更显著,术后恢复至术前水平所需时间更长;而作为内源性凝血刺激因子的缓激肽,在围手术期与凝血因子Ⅻ具有相似的变化规律。凝血因子Ⅻ及缓激肽可能成为纠正围手术期凝血功能障碍的新靶点。

英文摘要：

Objective：To describe the changing state of intrinsic coagulation substances during the surgery with acute aortic dissection,find a new target against coagulopathy in perioperative period,directing at reducing hemorrhage related complications and the burden on blood transfusion of the surgery.Methods：88 patients undergoing emergent surgery for acute aortic dissection were enrolled in this study.The change of intrinsic coagulation pathway and,on comparison,the extrinsic coagulation pathway were evaluated at 5 different time points during the perioperative period,by measuring intrinsic coagulation factor Ⅻ and activated factor Ⅻ,stimulating factors including prekallikrein,highmolecularweightkininogen,brandykininandhistone-DNA-complex,extrinsic coagulation factor Ⅶ and activated factor Ⅶ,respectively.Results：Compared with factor Ⅶ,factor Ⅶ demonstrated a higher proportion of decline during operation （its proportion of decline from T1 to T2 was 42%,while the proportion of decline from T1 to T2 of factor Ⅶ was 20%,P 〈 0.001）.Moreover,factor Ⅶ recovered to preoperative level at T4 with relative faster speed （P 〈 0.001）,while factor XⅫ still did not return to preoperative level until T4 （P =0.01）.The preoperative level of brandykinin was higher than normal range,while reached the minimun level during hypothermic circulatory arrest,and then gradually increased to a higher level than that of preoperative,reaching the highest level 4hours after operation.Other stimulating factors includingprekallikrein,highmolecularweightkininogenandhistone-DNA-complex did not show a significandy changing trend during operation（P 〉 0.05）.Conclusion：Compared with coagulation factor Ⅶ,factor Ⅻ is inhibited more seriously and recovers to preoperative level with a longer time.Brandykinin,as a stimulating factor of intrinsic pathway,has a similar changing trend with coagulation factor Ⅻ.The supplement of coagulation factor Ⅻ and brandykinin during the perioperative period may be a promotin