小剂量乌司他丁对门脉高压脾切除术后患者凝血功能的影响

Effect of low-dose Ulinastatin on blood coagulation function of portal hypertension in patients with splenectomy

目的观察小剂量乌司他丁对门脉高压脾切除患者术后凝血功能的影响。方法回顾分析115例门脉高压行脾切除患者的临床资料，分对照组（n=68）和乌司他丁组（n=47）。乌司他丁组于术后当日在对照组治疗的基础上给予乌司他丁100000U／d，连用5d。分别在术前、术后1d、3d、5d空腹采血测定凝血酶原时间（PT）、凝血酶原活动度（PTA）、活化部分凝血酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）。结果乌司他丁组于术后3d、5d，胛显著短于术前（均P〈0．01），PTA显著高于术前（均P〈0.01）。与对照组比较，手术后1d、3d、5d，APTT，TT延长，但差异无统计学意义（均P〉0．05）。2组术后门静脉血栓发生率比较差异无显著性（P〉0．05）。结论脾切除术后静脉滴注低剂量乌司他丁100000U／d，可适当延长APTT和TT，改善术后患者的凝血状态，但不能减少术后门静脉血栓形成。

Objective To investigate the effects of low-dose ulinastatin （UTI） on blood coagulation function in patients with portal hypertension after splenectomy. Methods 115 patients with portal hypertension, 77 males and 38 females, aged 46.5 （12-65）, undergoing splenectomy were randomly divided into 2 sex, age, liver function, Child-Pugh score, and history of upper digestive system hemorrhage-matched groups： UTI group （n=47） intravenously administered with UTI 100,000 units per day for 5 days in addition to conventional therapy from the operation day to the fourth day after the operation, and control group （n=68） given the conventional therapy. Peripheral blood samples were collected before operation, and 1, 3, and 5 days after operation. Prothrombin time （PT）, prothrombin time activity （PTA）, activated partial thromboplastin time （APTT）, thrombin time （TT）, and fibrinogen （FIB）, and D-dimer （D-D） were measured. Results Three and 5 days after operation the PT levels were significantly shorter than that before operation （both P〈0.01）, and the PTA levels were significantly longer （both P〈0.01） in the UTI group. The APTT and TT levels 1, 3, and 5 days after operation of the UTI group were longer than those of the control group, however, not significantly （all P〉0.05）. The FIB level 5 days after operation of the UTI group was significantly lower than that before operation （P〈0.05）, however, there were not significant differences in the FIB levels at different time points in the control group （all P〉0.05）. There were not significant differences in the D-D levels at different time points between these 2 groups （all P〉0.05）, and there was no significant difference in the perioperative portal vein thrombosis rate between the 2 groups （P〉0.05）. Conclusion Low-dose UTI prolongs the APTT and TT, thus modifying blood coagulation status, but cannot prevent pylethrombosis post-operatively.