全膝关节置换过程中应用气囊止血带与高凝状态的关系

Relationship between pneumatic tourniquet application in total knee arthroplasty and hypercoagulability

背景:大量研究表明在全膝关节置换过程中使用气囊止血带对患者的血流动力学影响较大,可导致高凝状态甚至深静脉血栓。目的:观察全膝关节置换过程中应用止血带与高凝状态关系。方法:39例全膝关节置换患者随机分为止血带组(n=20),非止血带组(n=19)。两组于术前、止血带组止血带放气后5min及非止血带组术后均测定血液流变、D-二聚体、纤维蛋白原降解产物、抗凝血酶-Ⅲ。结果与结论:两组术前各指标比较差异无显著性意义(P>0.05)。两组红细胞变形指数TK、抗凝血酶-Ⅲ术后均较术前明显降低,红细胞聚集指数、红细胞刚性指数、D-二聚体、纤维蛋白原降解产物术后均较术前明显升高(P<0.05)。止血带组红细胞聚集指数、红细胞刚性指数、D-二聚体、纤维蛋白原降解产物较非止血带组明显升高,红细胞变形指数TK、抗凝血酶-Ⅲ较非止血带组明显降低(P<0.05)。结果提示,全膝关节置换的创伤和止血带的使用均可导致高凝状态,但止血带可加重高凝状态,有下肢深静脉血栓形成倾向。

BACKGROUND：Numerous studies show the pneumatic tourniquet on hemodynamics during total knee arthroplasty （TKA） can lead to hypercoagulability or deep vein thrombosis.OBJECTIVE：To investigate correlation between tourniquet and hypercoagulability during TKA.METHODS：The 39 cases undergoing TKA were randomly divided into two groups：tourniquet group （n=20） and non-tourniquet group （n=19）.Hemorheology,D-dimer,fibrinogen degradation products （FDP） and antithrombin-Ⅲ （AT-Ⅲ） were measured pre-,5minutes after of the first tourniquet deflation in the tourniquet group and post-operation in the non-tourniquet group.RESULTS AND CONCLUSION：The indexes of two groups had no differences before operation （P0.05）.After operation,red blood cell deformability index TK and AT-Ⅲ were significantly reduced than that before surgery,while erythrocyte aggregation index,erythrocyte rigidity index,D-dimer and FDP were significantly greater than that before surgery （P0.05）.Erythrocyte aggregation index,erythrocyte rigidity index,D-dimer and FDP were significantly increased,while red blood cell deformability index TK and AT-Ⅲ were significantly decreased in tourniquet group compared with non-tourniquet group （P0.05）.Results show that trauma of TKA and the application of tourniquet during surgery can lead to hypercoagulable state.The use of pneumatic tourniquet during TKA exacerbated hypercoagulable state,which prone to deep venous thrombosis.