人工髋关节置换术围手术期凝血、抗凝活性变化

Perioperative determination of blood coagulation and the activity of anticoagulation in patients receiving total hip arthroplasty

目的:检测人工髋关节置换术围手术期凝血、抗凝活性,探讨手术方式本身对凝血、纤溶活性的影响规律,为评估人工关节置换后的血栓性疾病并发症提供理论依据。方法:选择人工髋关节置换患者50例,分别于术前、术后即刻、术后24 h、术后3 d检测凝血指标(凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原),抗凝指标(抗凝血酶Ⅲ、抗Ⅱ因子活性),纤溶指标(D-二聚体),并进行分析比较。结果:术前、术后凝血酶原时间、活化部分凝血活酶时间比较差异无统计学意义(P>0.05),纤维蛋白原术后即刻减低(P<0.05),术后24 h,3 d增高(P<0.05);术后抗凝血酶Ⅲ、抗Ⅱ因子活性较术前降低(P>0.05);D-二聚体术后即刻、术后24 h增高(P<0.05),术后3 d恢复正常(P>0.05)。结论:人工髋关节置换术围手术期存在凝血活性增强,抗凝活性变化不明显、纤溶活性增强的失动态平衡状态,血栓性疾病的发生倾向明显增强。

Objective To research the influence of the total hip arthroplasty on the blood coagulation and the activity of fibrinolysis to give theoretical data for evaluating the risk of thromboembolic disease in total hip arthroplasty by determining the blood coagulation and the activity of anticoagulation during operation. Methods Fifty patients receiving total hip arthroplasty and 50 normal controls were determined coagulation indexes （prothrombin time, APTT, fibrinogen）, anticoagulation indexes（antithrombin Ⅲ , Ⅱ a）, and fibrinolysis index（D-dimer）. Results There were no statistic differences in prothrombin time, APTT, antithrombin Ⅲ and a levels between two groups during operation （P〉0.05）. Fibrinogen decreased obviously after operation（P〈0.05） and increased 24 hours and 3 days after operation（P〈0.05）. D-dimer increased 24 hours after operation （P〈0.05） and returned normal 3 days later（P〉0.05）. Conclusion The activity of blood coagulation increases, the activity of blood antieoagulation does not change significantly, and the activity of fibrinolysis increases in perioperative period, which increases the tendency of thromboembolic disease.