経静脈的ペースメーカー植え込み前後における凝血学的検討

The Study of Blood Coagulation before and after Transvenous Pacemaker Implantation

　ペースメーカー（PM）植え込み後における血栓形成の病態を検討するため，植え込み前後で凝血学的検査を行った．対象は新規にPMを植え込んだ22例で，前，2週間後，3カ月後のトロンビン・アンチトロンビンIII複合体（TAT），フィブリノペプチドA・Bβ15-42，Dダイマー，α₂プラスミンインヒビター・プラスミン複合体（PIC），FDP，フィブリノーゲン，APTT,PT比，プラスミノーゲン，アンチトロンビンIII（AT III），血小板数，血小板粘着能・凝集能を比較した．TATはPM前3.2±2.2ng／mlに比し，2週間後6.1±2.5ng／ml,3カ月後4.4±3.2ng／mlと有意な上昇を示し，3カ月後においても14例（64％）で異常高値を認めた．Dダイマー，PIC,FDPは2週間後には有意な上昇を認めたが，3カ月後には差はなかった．他の凝血学的因子はPM前後で変化はみられなかった．PM植え込み後には，血液凝固系の持続的な亢進状態が多くの例で存在し，PM管理上留意すべきと考えられた．

Blood coagulation parameters were evaluated before and after implantation of an intravenous pacemaker (PM) to determine thrombogenetic conditions after its implantation. Subjects were 22 cases of initial im-plantation of PM. Selective parameters were deter-mined before implantation, and two weeks and three months after implantation, and comparisons were made of their values: thrombin-antithrombin III complex (TAT), fibrinopeptide A and Bβ_15-42,α₂ plasminin-hibitor-plasmin complex (PIC), D dimer, FDP, fibrinogen, APTT, PT ratio, plasminogen, antithrombin III.platelet count, platelet adhesiveness, and platelet aggregation. TAT showed 3.2±2.2ng/ml before PM implantation. This increased significantly to 6.1±2.5 ng/ml and 4.4±3.2ng/ml, two weeks and three months after PM implantation, respectively. Even three months after implantation, 14 cases (64%) showed an abnor-mally high level of TAT. Although a significant increase was shown in D dimer, PIC and FDP two weeks after implantation, no significant difference was obser-ved three months after implantation. Other coagulation parameters did not show any changes before and after PM implantation. It is suggested that persistent activa-tion of the blood coagulation system is produced in cases of PM implantation. This requires close attention in PM management.