血凝酶对人工髋关节置换术患者术后下肢静脉血栓形成的影响

Effects of hemopexin on venous thrombosis in patients underwent artificial hip replacement

目的观察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40例行人工髋关节置换术患者随机均分为两组:血凝酶组术前5min肌肉、静脉各注射血凝酶1kU;对照组以生理盐水代替血凝酶作为对照。于用药前及用药后60、120min抽取外周静脉血,测定D-二聚体(D-D)、抗凝血酶(AT)活性、凝血酶原时间(PT)和活化部分的凝血酶原时间(APTT)、组织型纤溶酶原激活剂(tPA-Ag)和组织型纤溶酶原激活抑制剂(PAI-1),用药前后进行双下肢静脉血管超声检查。结果术后3～10d血凝酶组发现远端静脉血栓5例(25.0%);对照组6例(30.0%)。血凝酶组给药后60min时tPA-Ag明显高于对照组(P<0.05);两组其他相关凝血指标差异均无统计学意义。结论术中应用血凝酶对患者凝血功能无明显影响,不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。

Objective To investigate the influence of the hemopexin on the formation of venous thrombosis in patients underwent total hip replacement（THR）. Methods Forty THR patients were randomly divided into two groups with 20 cases each. The patients in hemopexin group were given hemopexin 1 KU intramuscularly and 1 KU intravenously 5 min before operation. Those in control group were injected normal saline instead of hemopexin as the controls. Venous blood samples were taken before drug injection, at 60 and 120 min after that for the measurements of D-dimer （D-D）, activity of anticoagulation （ AT）, prothrombin time （ PT）, activated partial thromboplastin time （APTT）,tissue-plasminogen activator（tPA-Ag） and plasminogen activator inhibitortor（PAI-1）. All patients were received the vascular ultrasound examination on the both lower extremities at the same time points. Results The venous thrombosis occurred in 3 to 10 days after operation was found by vascular ultrasound in 5 cases （25.0%） in hemopexin group and 6 cases （30.0%） in control group. tPA-Ag at 60 rain after hemopexin was significantly higher in hemopexin group than that in control group （P〈 0. 05）. Conclusion The application of hemopexin in THR patients has no significant impact on the coagulation function and does not increase the incidence of venous thrombosis,but may increase the activity of plasminogen.