乌司他丁对老年髋部手术患者血小板和凝血功能的影响

摘要

Objective To evaluate the effect of ulinastatin on platelet aggregation and coagulation function in elderly patients undergoing hip surgery. Methods 60 elderly patients in department of orthopedics were selected, who would have hip surgery with ASA I to III, and were randomly divided into observed group(30 cases) and control group(30 cases). The patients in observed group received intravenous injection of ulinastatin with a dose of 5000 U·kg-1 respectively after operation. The patients in control group received the same volume of normal saline instead of ulinastatin. Blood samples of two groups were taken preoperatively,at the 1st,2nd hour after the infusion for determination of PT,APTT,TT,p1asma D-dimer and PAGM. Deep vein thrombosis was also examined through color doppler ultrasonography on the postoperative 3 days respectively. Results Compared with T0 respectively,APTT,PT and TT in observed group were prolonged significantly at T1 (P<0.05) and PT and TT were also prolonged at T2(P<0.05)while APTT and TT in control group were became shorter at T1 and T2. Compared with control group and PT,APTT and TT in observed group were prolonged significantly(P<0.05 or <0.01). In both groups,after the surgery,the p1asma D-dimer were higher significantly than that before surgery(P<0.05),and it was lower significantly in observed group than in control group at 1 day and 2 day after surgery respectively(P<0.05),while there was no significant difference at the 3rd day after surgery between two groups. There were 12 cases of DVT in the control group(40%),and no case occurred in the observed group. Conclusion Intravenous infusion of ulinastatin during operation can prolong APTT,lower p1asma D-dimer,correct blood hypercoagulability and prevent the occurrence of DVT in some degree.%目的 观察乌司他丁对老年髋部手术患者血小板聚集及凝血功能的影响.方法 选择60例我院骨科住院老年患者,拟行髋部手术,ASAⅠ~Ⅲ,随机分为观察组(30例)和对照组(30例).观察组在手术开始后按照5000U/kg静脉输注乌司他丁,检测输注乌司他丁前30min(T0)、输注后1h(T1)、输注后2h(T2)3个时间点患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT),D-二聚体以及血小板最大聚集率(PAGM).术后3天应用彩色多普勒超声检查下肢深静脉血栓(DVT).对照组输注同剂量的生理盐水,在同一时点检测凝血指标.结果 观察组T1时间点的APTT、PT、TT较T0时间点延长(P均<0.05),T2时间点的PT、TT均较T0时间点延长(P均<0.05).对照组T1、T2与T0时间点比较,APTT和TT均缩短(P均<0.05).与对照组相比,观察组T1和T2时间点的PT、APTT、TT延长(P<0.05或<0.01.两组术后D-二聚体水平均较术前升高(P均<0.05),观察组术毕、术后1和2d时D-二聚体水平均低于对照组(P均<0.05),而术后3d观察组与对照组D-二聚体水平比较差异无统计学意义(P>0.05).术后第3天对照组有12例形成DVT(40%),观察组无DVT发生(P<0.05).结论 老年髋关节置换术中应用乌司他丁可适当延长APTT和PT,降低D-二聚体水平,改善术后高凝状态,预防术后DVT,具有较好的临床应用价值.