前列地尔联合低分子肝素改善膝关节置换术后凝血功能的疗效观察

Clinical observation of alprostadil combined with low molecular weight heparinon improvement of coagulation function after bilateral total knee arthroplasty

目的探讨前列地尔联合低分子肝素改善止血带加压下行双侧膝关节置换术（TKA）患者术后凝血功能、下肢深静脉血栓（DVT）形成的疗效观察。方法选取2014年1月—2015年2月包头市第四医院收治的择期硬膜外联合蛛网膜下腔阻滞麻醉下行双侧TKA的患者60例,将患者随机分为对照组和治疗组,每组30例。对照组患者采用弹力绷带加压包扎,并于术后第1天开始皮下注射低分子肝素6 k U/d,1次/d,直至术后7 d。治疗组患者在对照组基础上止血带加压前静脉滴入前列地尔注射液10μg,并于术后24、48、72 h分别静脉滴入前列地尔注射液10μg。分别在手术前24 h以及术后6、24、48、72 h抽取上肢外周静脉血,检测凝血功能和血液流变学,术后行下肢血管超声检查血栓形成情况。结果术后6 h两组活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）与术前24 h比较明显减小（P〈0.05）,术后72 h治疗组PT高于对照组（P〈0.05）;两组纤维蛋白原（FIB）在术后24~72 h比术前24 h明显增加（P〈0.05）;两组D-二聚体在术后6~72 h较术前24 h明显增加（P〈0.05）,其中术后24、48 h两组比较,治疗组明显低于对照组（P〈0.05）。术后48、72 h两组全血高切相对指数和全血低切相对指数与术前24 h比较明显增加（P〈0.05）,术后24 h全血高切相对指数治疗组低于对照组（P〈0.05）,术后24~72 h全血低切相对指数治疗组低于对照组（P〈0.05）;术后6~72 h两组血浆黏度较术前24 h明显增加（P〈0.05）,其中在术后24~48 h治疗组低于对照组（P〈0.05）;术后6~72 h两组红细胞聚集指数高于术前24 h（P〈0.05）,其中术后24~48 h治疗组低于对照组。小腿肌间静脉血栓治疗组明显少于对照组（P〈0.05）。结论行双侧TKA的患者应用前列地尔注射液联合低分子肝素能够改善术后血液高凝状态和血液流变学,减缓血栓的形成。

Objective To investigate the effect of alprostadil combined with low molecular weight heparinon on improvement of coagulation function and the incidence of deep vein thrombosis（DVT） after bilateral total knee arthroplasty（TKA） under tourniquet inflation. Methods Patients（60 cases） with epidural anesthesia of The Fourth Hospital of Baotou from January 2014 to February 2015 were randomly divided into control and treatment groups, and each group had 30 cases. All patients received the same combined spinal epidural anesthesia. The patients in the control group iv administered with low molecular weight heparin 6 k U/d at first day after surgery, once daily, and received treatment for 7 d after surgery. The patients in the treatment group were iv administered with Alprostadil Injection10 μg on the basis of control group before tourniquet inflation, and then at 24, 48, and 72 h after surgery, respectively. Peripheral venous bloods from patients were drawn from the upper limbs, and coagulation function and hemorrheology were detected at 24 h before surgery, and 6,24, 48, and 72 h after surgery. Thrombosis in lower extremity vein was detected by ultrasound after surgery. Results Compared with index at 24 h before surgery, APTT and PT in two groups were significantly decreased at 6 h after surgery（P 〈 0.05）, and PT in the treatment group was prolonger than that in the control group at 72 h after surgery（P 〈 0.05）. Compared with index at 24 h before surgery, FIB in two groups was significantly increased from 24 h to 72 h after surgery（P 〈 0.05）. D-dimer in two groups was obviously increased from 6 h to 72 h after surgery compared with index at 24 h before surgery（P 〈 0.05）, and D-dimer in the treatment group was significantly less than that in the control group at 24 and 48 h after surgery（P 〈 0.05）. Compared with index at 24 h before surgery, the whole blood high shear relative index and whole blood low shear relative index in two groups was increased at 48 and 72 h after surgery（P 〈 0.05）. The whole blood high shear relative index in the treatment group was lower than that in the control group at 24 h after surgery（P 〈 0.05）, and whole blood low shear relative index in the treatment group was lower than that in the control group from 24 h to 72 h after surgery（P 〈 0.05）. Plasma viscosities in two groups were obviously increased from 6 h to 72 h after surgery（P 〈 0.05）, and plasma viscosity in the treatment group was lower than that in the control group from 24 h to 48 h after surgery（P 〈 0.05）. Compared with index at 24 h before surgery, red cell assembling index in two groups was increased from 6 h to 72 h after surgery（P 〈 0.05）, and red cell assembling index in the treatment group was lower than that in the control group from 24 h to 48 h after surgery（P 〈 0.05）. The incidence of thrombosis in venous of lower extremity skeletal muscle in the treatment group was less than that in the control group（P 〈 0.05）. Conclusion Alprostadil Injection combined with low molecular weight heparinon can improve hemagglutination state and hemorheology postoperatively and decelerate the formation of thrombosis in patients with epidural anesthesia after TKA under tourniquet inflation.