巴曲亭应用于全髋关节置换术对手术出血的影响

The effect of batroxobin on bleeding during the total hip arthroplasty

目的探讨巴曲亭应用于全髋关节置换术(THA)对手术出血的影响。方法将62例行THA的患者随机分为治疗组(32例)与对照组(30例)。两组患者术前均使用低分子肝素抗凝治疗,治疗组巴曲亭2U溶于5 ml的生理盐水中,切皮前10 min静脉注射,术中磨削髋臼及扩髓使用2U巴曲亭溶于20 ml的生理盐水中局部喷洒于截骨面;对照组切皮前10 min注射同剂量的生理盐水,术中磨削髋臼及扩髓使用20 ml的生理盐水局部喷洒于截骨面。记录术中出血量、术后24 h引流量,检测术前及术后24 h凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)等,术后第3天复查下肢深静脉血栓,记录患者住院时间。结果术中出血量:治疗组为(325.14±85.21)ml,明显低于对照组的(513.45±102.05)ml(P<0.05)。术后24 h引流量:治疗组为(251.21±74.08)ml,明显低于对照组的(356.35±101.29)ml(P<0.01)。两组患者术毕及术后24 h PT、TT、APTT均较术前有所延长,但治疗组差异无统计学意义(P>0.05),对照组差异有统计学意义(P<0.05)。两组术毕及术后24 h FIB均较术前下降,但治疗组差异无统计学意义(P>0.05),对照组差异有统计学意义(P<0.05)。术后第3天治疗组发生2例下肢深静脉血栓和1例深部血肿,对照组发生1例下肢深静脉血栓,两组均未发生切口感染。两组患者住院时间差异无统计学意义(P>0.05)。结论巴曲亭应用于THA可以减少术中出血量及术后引流量,不影响患者的凝血效果,疗效确切,具有安全性。

Objective To explore effect of the use of batroxobin to treat the hemorrhage during the total hip arthro-plasty（THA）. Methods Sixty-two patients underwent THA were randomly divided into treatment group （32 cases） and control group （30 cases）. Both groups of patients were applied for low molecular heparin anticoagulant therapy preoperatively, treatment group were used 2 U batroxobin dissolved in 5 ml of normal saline, preoperative intravenous injection before 10 min cut skin, intraoperative grinding acetabulum and enlarge pulp using 2 U batroxobin and 20 ml of normal saline local spray to cut bone cutting surface. Control group 10 min before cutting leather injection with preo-perative dose of normal saline, intraoperative grinding acetabulum and enlarge pulp using 20 ml saline local spray to bone cutting surface. Intraoperative bleeding and postoperative drainage volume of 24 h, preoperative and postopera-tive 24 h prothrombin time （PT）, thrombin time （TT）, activated partial thromboplastin time（APTT）, fibrinogen （ FIB） were compared. Two groups of patients were reexamed lower extremity deep vein thrombosis（ DVT） on postop-erative three days, and were reviewed the hospital stay. Results The volume of intraoperative blood loss in treatment group（325. 14 ± 85. 21）ml was significantly lower than the control drain and detection in patients group （513. 45 ± 102. 05） ml （P〈0. 05）. After 24 hours to drain （251. 21 ± 74. 08） ml significantly lower than the control group （356. 35 ± 101. 29）ml（P〈0. 01）; two groups of patients with postoperative and dostoperative 24 h PT, TT and APTT were longer than before, but there was no statistically significant difference in treatment group （ P〉0. 05 ） , control group was statistically significant difference （ P 〈0. 05 ） , postoperative and dostoperative 24 h FIB of two group were compared with the preoperative decl-ine, but there was no statistically significant difference in treatment group （P〉0. 05）, the control group difference was statistically significant （P〈0. 05）. The treatment group patients found in 2 cases lower extremity DVT and 1 case of deep hematoma on the third day, control group found 1 case of lower extremity DVT, no obvious difference was found between two groups of patients in hospital time （P〉0. 05）. Conclusions The batroxobin can reduce intraoperative blood loss and postoperative flow,it do not affect the patient′s blood coagulation effect, curative effect and securiy.