硝苯地平、肝素钠在组织移植中的应用

The application of nifedipine and heparin sodium in tissue transplantation

目的分析硝苯地平、肝素钠在组织移植病例中的抗凝作用，为临床合理使用抗凝药物提供依据。方法对２０例行游离组织移植的患者，术后除常规使用低分子右旋醣酐、丹参外，随机给予硝苯地平（硝苯地平组１０例）和硝苯地平加肝素钠（肝素钠组１０例）药物。两组均于手术前、手术中、手术后２４、７２、１２０小时抽血，进行血液生物化学测定，观察药物的凝血作用。结果术后２４、７２小时肝素钠组的白陶土部分凝血活酶时间（ｋＰＴＴ）均较术前明显延长；术后７２小时和术前相比，两者差异有显著性意义（Ｐ＜０．０１）。两组各时间段的凝血酶原时间、抗凝血酶－Ⅲ、纤溶酶原、Ｄ－二聚体等，与术前相比均无显著性差异。结论肝素钠的抗凝血作用较强，可减少血栓的形成与扩展；但其作用时间长，故仅宜小剂量使用，作游离皮瓣移植时要慎用。硝苯地平有减轻术后机体高凝状态的作用，无不良反应。

Objective To evaluate the anticoagulating effect of nifedipine and heparin sodium in tissue transplantation. Methods 20 cases of free tissue transplantation operated from 1995 to 1997 were involved in this trial. Low molecular weight dextran and Danshen were routinely applied postoperatively. Nifedipine was randomly used in 10 cases, and nifedipine together with heparin sodium was given in the other 10 cases. Biochemical testing of blood coagulation was taken before the operation, in the operation, 24 hours, 72 hours and 120 hours after the operation successively. Results The Kaolin Partial Thromboplastin Time(kPTT) of the heparin group was obviously prolonged at 24～72 hours postoperatively. kPTT at 72 hours was significantly longer than that before the operation(P<0.01). There was no significant difference of Thrombinogen Time, Antithrombin III, Plasminogen and D dimer pre and postoperatively. Conclusions Heparin has strong anticoagulating effect which can limit the formation and expansion of thrombosis. Small dosage application is recommended because of its long effective period. It should also be used with caution in free flaps. Nifedipine can antagonize the postoperative high coagulating status without any adverse effects. Therefore, it can be widely prescribed.