乌司他丁对髋关节置换患者围术期凝血功能和深静脉血栓形成的影响

Effects of ulinastatin on coagulation function and deep vein thrombosis in patients undergoing hip joint replacement

目的比较乌司他丁（Uti）与低分子量肝素（Lmwh）对髋关节置换患者围术期凝血功能和深静脉血栓（DVT）形成的影响。方法2010年3月至12月选择美国麻醉医师协会（ASA）I-Ⅱ级择期行髋关节置换术患者150例，年龄65—85岁，平均72．5岁。随机分成生理盐水（NS）对照组（C组）、Uti组（U组）和Lmwh组（L组），每组50例。U组在术前1d、术中、术后第1、2、3天缓慢静脉注射Uti1万U／kg；C组只给予等量NS；L组术前1d、术后第1、2、3天腹壁皮下注射Lmwh3200U／d，但手术日及术中不给药。分别于术前（T0）、术毕（T1）、术后1d（T2）、2d（T3）、3d（T4）5个时间点抽取静脉血标本，以凝血弹性描记仪（TEG）检测各组患者的凝血功能；术后3d以彩色超声（CDFI）检查患者DVT的形成。结果（1）C组患者处于相对高凝状态，其中术后1d达最高峰，至术后3d则有恢复趋势；在T1、T2、T1各观察时间点中：与C组相比，U组、L组中的凝血反应时间、凝血形成时间值均延长、凝血形成速率、凝血最终强度、凝血综合指数均减小（P〈0．01）。经Uti及Lmwh处理，患者呈相对非高凝状态；（2）L组患者术中出血量、术后1d引流量大于U组、C组；（3）术后3d，C组、U组DVT发病数分别为20例（发病率为40％）及1例（发病率为2％），L组患者无DVT发生。结论Uti、Lmwh均能有效改善髋关节置换患者围术期高凝状态，降低术后DVT的发病率。但Lmwh一定程度上增加术中与术后手术部位出血量。

Objective To investigate the effects of ulinastatin （Uti） and low-molecular-weight heparin （Lmwh）on coagulation function and deep vein thrombosis（DVT） in patients undergoing hip joint replacement. Methods From March to December 2010 150 ASA I - II patients with average age of 72. 5 （65-85） years undergoing hip joint replacement were randomly divided into 3 groups （n = 50 each） ： normal saline （NS）control group （Group C）, Uti group（ Group U） and Lmwh group （Group L）. Group U received intravenous infusion of ulinastatin（ 10 000 U/kg） at preoperative, perioperative and after operation 1, 2 and 3 d, respectively. Group C received the same volume of NS instead of Uti. Group L were injected Lmwh subcutaneously （3200 U/d） at preoperative, after operation 1, 2 and 3 d. Blood samples were taken before operation（ To ）, at the end of surgery（ T1 ）, 1 d（ T2 ） ,2 d（ T3 ） and 3 d（ T4 ） after operation for determination the values of R, K, αangle, MA and CI, using thromboelastography, and the DVT were also examined through color Doppler ultrasonography at 3 d after operation. Results Compared with To, R, K were shorter, c~ angle,MA and CI were larger in group C, the values at T2 were up to the peak then declined at T4. Compared with group C, the value of R, K were larger, the value of α angle, MA and CI were shorter in group U and group L. The DVT checked by ultrasonography were found in 20 cases in group C, 1 ease in group U, and zero case in group L The differences were no statistically significant between group U and group L Conclusion Intravenous infusion of Uti during the period of operation can correct the hypereoagulability of blood and decrease the incidence of DVT after operation.