关节手术病人血浆凝血酶-抗凝血酶复合物的研究

Research of TAT and PAP in joint operation patients

目的 通过监测凝血酶-抗凝血酶复合物（TAT）、血凝常规等指标的动态变化，来探讨髋、膝关节手术病人血栓前状态和血液中凝血系统的变化，以及各指标与深静脉血栓形成（OVT）的相关性。方法选取需行髋、膝关节置换术的病人85例，随机分为以下2组：①关节手术组：44例，男23例，女21例，年龄49。82岁，平均65．2±16．4岁；②保守治疗组：41例，男24例，女17例，年龄57—81岁，平均69．1±11．7岁。取我院查体中心健康查体人员为对照组：35例，男19例，女16例，年龄52—82岁，平均66．8±14．8岁。以上各组病例均排除栓塞性疾病，肿瘤，结缔组织病，胃、十二指肠溃疡，严重肝肾疾患，严重心脑血管疾病，血液病以及血小板计数低于正常者；近期（1个月内）无严重感染病史、手术及外伤史；近期（1个月内）无服用抗血小板药、抗凝药及影响凝血一纤溶活性的药物史。每组病人术前及术后1、4、7、10天检测TAT、血凝常规等指标（非手术组入院第3天定为术后1天，依次类推）；术前及术后第7—10天应用彩色多普勒超声仪监测DVT。结果①手术组共有18例（40．9％）术后并发DVT，保守组共有9例（22．0％）并发DVT，对照组无DVT发生；②手术组术后并发DVT者术前及术后TAT均显著升高。结论术后并发DVT者术前平均TAT水平显著高于未并发DVT者，因此术前TAT检测可作为术后是否并发DVT的一项较有意义的预测指标。

Objective: To evaluate the prethrombus and coagulation system changes in hip joint and knee joint operation patients and the correlation between above factors and DVT by monitoring dynamic changes of Plasma thrombin-antithrombin complex(TAT) and blood coagulation routine.Methods: 85 patients needing hip or knee joint replacement were selected and were divided into two groups randomly:(1) joint operation group: 44 cases with 23 males and 21 females at the age ranging from 49 to 82 years(mean 65.2±16.4);(2) conservatives treatment group: 41 cases with 24 males and 17 females at the ages ranging from 57 to 81 years(mean 69.1±11.7).The contrast group was from 35 healthy people with 19 males and 16 females at the ages ranging from 52 to 82 years(66.8±14.8).In the three groups,the diseases,such as embolism disease,tumor,connective tissue diseases,gastric and duodenal ulcer,severe liver and kidney disease,severe cardinal and cerebral disease,blood disease and lower platelet counting,were eliminated.In recent days,they had no severe infection history,operation and trauma,no history of taking anti-platelet drugs,anticoagulant drugs and any affecting coagulation-fibrinolytic system drug.In each group,blood coagulation routine was tested before operation and 1,4,7,10 days after operation.(In the conservative group and the contrast group,the third day after admission was regarded as the first day after operation.) DVT was tested using Doppler ultrasound diagnostic apparatus before operation and 7 to 10 days after operation.Results: ①18 cases in the operation group and 9 cases in the conservative group were complicated by DVT.There was no DVT in the contrast group.② In the operation group with DVT,TAT level was higher than that before and after operation.Conclusion: TAT level is significantly higher in the patients with DVT after operation than that with no DVT.Testing TAT before operation can be regarded as a significant forecast factor of whether DVT will happen after operation.