摘要
目的观察乌司他丁对止血带下接受双侧全膝关节置换术（TKA）患者术后凝血功能及下肢静脉血栓发生率的影响。方法选择拟在止血带下接受双侧TKA的患者30例，随机分为两组：U组在第一条止血带充气前10min、放气前10min、第二条止血带放气前10min分别静脉给予乌司他丁5kU／kg，C组在相同时间点给予生理盐水。所有患者的全身麻醉方案、血栓防治方案和功能康复方案均相同。分别在术前1d（T。）、术后4h（T2）、24h（]r3）、48h（T。）、72h（Ts）抽血检测凝血酶原时间（PT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）和D-二聚体（D-Dimer）。术后行下肢血管超声检查血栓形成情况。结果两组凝血功能指标差异无统计学意义。与T1时比较，T2、T3时两组FIB均明显下降（P〈0．05），T4、L时明显升高（P〈0．05）；T3～T4时两组APTT均明显延长（P〈0．05）；T2～T5时两组D-Dimer明显升高（P〈0．05）。U组血栓条数明显少于C组（P〈0．05），血栓总长度明显短于C组（P〈0．05）。结论在双侧TKA术前和术中应用乌司他丁可以减少下肢肌间静脉血栓形成数量，减缓血栓形成的速度，加快纤溶系统的恢复。
Objective To investigate the effect of ulinastatin on patients＇ postoperative coagulation function and the incidence of deep vein thrombosis （DVT） after bilateral total knee arthroplasty （TKA） under tourniquet. Methods Thirty patients, who were scheduled to receive bilateral TKA under tourniquet, were enrolled and randomly assigned to trial group （group U） and control group （group C）. Patients in group U received intravenous ulinastatin 5 kU/kg and in group C received the same volume saline 10 min before 1st tourniquet inflation, 10 min following tourniquet deflation, and 10 min before 2nd tourniquet deflation. All patients received the same general anesthesia, thrombosis prevention and rehabilitation programs. PT, FIB, APTT, and D-Dimer were measured on 1 day preoperatively（T1 ）, at 4 h（T2）, 24 h（T3）, 48 h（T4）, 72 h（T5 ） postoperatively. Results There was no difference in coagulation function between the two groups. Compared with T1, FIB in two groups significantly decreased at T2, T3 increased at T4, Ts, APTT in two groups significantly prolonged at T3-T5, D-Dimer in two groups obviously increased at T2-T5（P〈0.05）. The quantity of thrombosis in group U was less than group C（P〈0.05）. The total length of thrombosis in group U was shorter than group C（P〈0.05）. Conclusion The application of ulinastatin in bilateral TKA can decrease the number of thrombosis in calf muscular veins. It can decelerate the formation of thrombosis and promote the recovery of fibrinolysis system.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第4期333-335,共3页
Journal of Clinical Anesthesiology
基金
天普研究基金(01201013)
关键词
全膝关节置换术
乌司他丁
止血带
凝血功能
深静脉血栓
Total knee arthroplasty
Ulinastatin
Tourniquet
Coagulation function
Deep vein thrombosis
