大剂量乌司他丁对腔镜甲状腺瘤切除术术野质量及凝血功能的影响

Effect of High-dose Ulinastatin on Blood Coagulation and Quality of Surgery Field in the Patients Undergoing Endoscopic Thyroidectomy

目的:观察乌司他丁对腔镜甲状腺瘤切除术患者术野质量和出血量的影响。方法:腔镜甲状腺瘤切除术患者40例随机分为乌司他丁组(U组,n=20)和0.9%氯化钠注射液组(N组,n=20),分别在入手术室后20 min内滴注乌司他丁10 000u·kg^(-1)和生理盐水各100 ml。分别于给药前(T_1)、给药后0.5 h(T_1)抽取静脉血,测定激活的凝血时间(ACT)、凝结速率(CR)、血小板功能(PF),l h后测定D-二聚体,记录开始手术后每15 min时间点的术野质量评分,记录术毕失血量和术后引流出血量。结果:与T_0时比较,U组ACT、CR、PF在T_1时明显升高(P<0.01或0.05)。D-二聚体U组和N组均升高(P<0.05),而U组明显低于N组(P<0.01);术野质量U组优于N组,术中出血量和术后引流量U组比N组明显减少(P<0.05或0.01)。结论:乌司他丁可升高腔镜甲状腺瘤切除术患者的ACT、CR、PF,抑制纤维蛋白的分解,减少手术出血量,提高患者的安全性。

Objective ： To investigate the effect of ulinastatin on blood coagulation and quality of surgery field in the patients under- going endoscopic thyroidectomy. Method： Totally 40 cases undergoing endoscopic thyroidectomy were randomly divided into two groups, ulinastatin group （ group U, n = 20） and normal saline group （ group N, n = 20）. The patients in the group U were intravenous- ly given 10 000 units · kg- 1 of ulinastatin mixed in 100 ml normal saline, while those in the group N received the same volume of nor- mal saline. Activated clotting time （ACT）, clotting rate （CR）.and platelet function （PF） in the two groups were detected using a Sonoclot eoagulometer at pre-infusion （ TO ） and 0.5 hour after the infusion （ TI ）. D-dimer （D-D） was measured at pre-infusion （ To ） and 1 hour after the infusion （ T2 ）. Blood loss was recorded. The score of surgical field quality was assessed by the surgeons at the 15th, 30th, 45th and 60th minute after the incision. Result： At T1 , ACT, clot rate and platelet function were increased （P 〈0.05 or 0.01 ） in the group U. ACT, clot rate and platelet function in the group U were higher than those in the group N. At T2 , D-dimer （ D- D） in the grorp N was obviously higher than that in the group U. The quality of surgery field in the group U was significantly better than that in the group N （P 〈 0.01 ）. The group U had less bleeding and shorter operation time compared with the group N （P 〈 0.05 or 0.01 ）. Conclusion： High-dose ulinastatin may improve the blood coagulation, and increase the quality of surgery field and the safety of the patients undergoing endoscopic thyroidectomy.