乌司他丁对髋关节置换术患者围术期D-二聚体＼血栓素B2水平的影响

Effect of ulinastatin on plasma D-dimer and thromboxane B2 in patients undergoing hip joint replacement

目的观察不同剂量乌司他丁对髋关节置换术患者围术期D-二聚体（DD）、血栓素B2（TXB2）水平的影响。方法选择80例无血液系统疾病（包括凝血功能障碍）的ASAI～Ⅱ级择期髋关节置换术患者，随机分为对照组（I组）、乌司他丁30万U组（Ⅱ组）、乌司他丁60万U组Ⅱ组）、乌司他丁1D0万U组（IV组），每组20例；分别于术前（T1）、术毕（T2）、术后3h（T3）、术后12h（T2）和术后24h（T5）采血测定DD、TXB2水平并进行比较分析。结果与术前比较，4组患者T2～115时DD水平升高（P〈0．05）。I、Ⅱ组T2～T5时TXB2水平升高（P〈0．01）．Ⅲ和IV组T2～T3时的变化无统计学意义（P〉0．05），T4～T5时逐渐升高（P〈0．01）；与I组比较，Ⅱ、Ⅲ、IV组T2～T2时DD水平降低（P〈0．01），Ⅱ组T：～T3、Ⅲ组和IV组T2～T2时血浆TXB2水平降低（P〈0．01）；与Ⅱ组比较。Ⅲ、IV组T2～L时DD、TXB2水平降低（P〈0．01）。结论术中静脉滴注60～100万U乌司他丁，可在一定时间内降低患者血浆DD、TXB2水平，改善其围术期的高凝状态。

Objective To investigate the effect of ulinastatin （Uti） on plasma D-dimer and thromboxane B2 levels in patients undergoing hip joint replacement. Methods Eighty ASA I - Ⅱ patients without hematological and blood coagulation disorders who underwent hip replacement operation were randomly divided into four groups （n=20 in each）： groups Ⅱ, III and IV received Uti 3 × 10^5 U, 6 × 10^5 U and 10 ×10^5 U, respectively; meanwhile, patients in group I received the same volume of 0.9% sodium chloride injection. Blood samples were drown from patients before （T1） and 0 h （T2）, 3 h （T3）,12 h （T4） and 24 h （T5） after operation, plasma D-dimer and thromboxane B2 levels were measured. Results Compared with group I, plasma D-dimer levels in groups Ⅱ, Ⅲ and IV were increased （P〈0.05）. Plasma thromboxane B2 levels in group I , group II at T2-T5 were increased （P〈0. 01）, but not for group Ⅲ and group IV at T2- T 3 （P 〉0.05 ）, which were gradually increased at T4- T5 （P〈 0.01 ）; Compared with group I , plasma D-dimer and thromboxane B2 levels were significantly lower at T2 - T 4 in group Ⅱ, group Ⅲ and group IV （P〈0. 01 ）; As compared with group Ⅱ, D-dimer and thromboxane B2 were significantly lower at T2-T 4 in group lU and group IV （P〈0. 01 ）. Conclusion Intravenous infusion of ulinastatin 6 × 10^5 U - 10 × 10^5 U during operation can reduce plasma D-dimer and thromboxane B2 levels within a certain period of time and correct blood hypercoagulability.