血凝酶在人工髋关节置换术中的应用及对术后下肢静脉血栓形成的影响

The Application of Hemopexin in the Artificial Hip Replacement and the Influence on Venous Thrombosis of Lower Extremities After Operation

目的观察髋关节置换术中应用血凝酶对患者凝血功能及其下肢静脉血栓形成的影响。方法采用随机对照将符合入选标准的患者随机分成实验组(血凝酶)和对照组(生理盐水)各20例,术前分别肌肉、静脉注射相应药物。在不同时间段抽取周围静脉血,测定 D-二聚体(D-D)、抗凝血酶(AT)活性、凝血酶原时间(PT)和活化部分的凝血凝血酶原时间(APTT)、组织型纤溶酶原激活剂(tPA)和组织型纤溶酶原激活抑制剂(PAI),用药前后检查双下肢静脉血管超声。结果远端静脉血栓11例中包括实验组5例、对照组6例。除 tPA 略有变化外,其他血栓相关指标均无明显变化。结论术中应用血凝酶对患者凝血功能无影响,术后下肢静脉血栓形成主要与手术创伤、术后制动及血栓的高危因数有关,术中应用血凝酶不会增加术后下肢静脉血栓形成的发生率,但可能会促进纤溶活性,与术后下肢静脉血栓形成无相关性。

Objective To review the influence of applicating Hemopexin in the artificial hip replacement on the ability of blood clotting and venous thrombosis of lower extremities. Methods 40 Patients were randomly equally divided into experiment group （Hemopexin） and control group （normal saline）. Medication was preformed by intramuscular injection before the operation. The value of dimeride, anticoagulation, prothrombin time, ctivated partial thromboplastin time, tissue-type plasminogen activator and plasminogen activator inhibitor were determined by drawing peripheral venous blood in different time. All patients were received the vascular ultrasound of both lower extremities before and after operation. Results There were 11 distal venous thrombosis patients, with 5 patients in experiment group and 6 in control group. Except change in value of tissue-type plasminogen activator, there were no other significantly differences between both groups. Conclusion The application of Hemopexin in the artificial hip replacement could not augment the incidence rate of lower extremities venous thrombosis after operation, but facilitate the activity of plasminogen.