乌司他丁对骨科大手术围手术期老年患者凝血功能的影响

The Effect of Ulinastatin on Coagulation Function on Department of Orthopedics Surgery in Elderly Patients with Perioperative Period

目的分析乌司他丁对骨科大手术围手术期老年患者凝血功能影响。方法选择2014年8月至2015年12月行骨科大手术患者140例,随机分为研究组与对照组,每组70例。研究组患者围手术期给予乌司他丁5000 U/(kg·h)持续泵注;对照组同期给予等剂量生理盐水输注。分别于术前、术中1 h以及术后6 h采外周静脉检测凝血酶原时间(PT)、部分凝血活酶时间(APTT),血栓弹力图测量其指标Angle角与MA值,散色比浊法检测血浆D-二聚体含量。酶联免疫吸附法检测血清白细胞介素-6(IL-6)与肿瘤坏死因子-α(TNF-α)含量变化。术后采用血管超声检测双侧下肢血管以及肌间从血管血栓形成发生率。结果 2组患者性别、年龄、体质量指数、手术类别、基础疾患等基础资料差异无统计学意义(P>0.05)。治疗前,2组患者凝血功能指标PT、APTT、Angle角、MA值、D-D值、IL-6、TNF-α以及下肢血栓形成发生率差异无统计学意义(P>0.05)。与术前比较,术中1 h与术后6 h,2组患者血浆PT、APTT时间延长、Angle角、MA值、D-D值增加,IL-6、TNF-α水平升高。其中,研究组患者血栓弹力图Angle角、MA值增加幅度与血清IL-6、TNF-α水平升高幅度不明显,与对照组比较,差异有统计学意义(P<0.05)。术后,研究组下肢静脉血栓发现率低于对照组,差异有统计学意义(P<0.05)。结论老年骨科大手术围手术期,给予乌司他丁持续泵入有助于改善患者血液高凝状态,加快纤溶系统功能恢复,减缓血栓形成速度,降低双下肢静脉血栓发生率以及相关临床出血并发症。

Objective To analyze the effect of ulinastatin on coagulation function on department of orthopedics surgery in elderly patients with perioperative period.Methods Between August 2014 and December 2015 the 140 cases of patients coming from department of orthopedics surgery were randomly divided into study group and control group of 70 cases.During perioperative period,the patients in the study group had received continuous infusion of ulinastatin 5000 U/（kg·h）;Meanwhile,the patients in the control group had been completed with the same dose normal saline infusion.Respectively in preoperative,intraoperative 1 h and postoperative 6 h,the index of prothrombin time（PT）,activated partial thromboplastin time（APTT）,thromboelastography measurement index：Angle angle and Ma value,and the detection of plasma D-dimer levels were analyzed.The levels of serum interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） were detected with enzyme-linked immunosorbent assay technology.After surgery,the incidence rate of vascular thrombosis coming form bilateral lower extremity vascular and muscle were detected by using vascular ultrasound.Results Before treatment,there was no significant difference between the two groups in basic data as for the index of PT,APTT,Angle,MA,D-D,IL-6,TNF-α and the incidence of lower limb thrombosis（P〈0.05）.Compared with preoperative,1 h and 6 h in postoperative,the index of plasma PT,APTT time,Angle angle,MA value,D-D value increased,IL-6,TNF-α levels increased in the two groups of patients.Among them,the index of Angle angle,MA value and the serum IL-6,TNF-α levels increased significantly in the study group,compared with the control group,the difference was statistically significant（P〈0.05）.After surgery,the incidence rate of lower extremity venous thrombosis in the study group was lower than that in the control group,the difference was statistically significant（P〈0.05）.Conclusion For the elderly patients coming form the orthopedic large surgery,ulinastatin continuous pumping treatment is helpful to improve the hypercoagulable state and accelerate the fibrinolytic system function recovery,slowing thrombosis rate,decrease the incidence rate of the clinically relevant bleeding complications occurred in lower extremity venous thrombosis.