人工关节置换术围手术期抗凝及纤溶活性变化

Changes of Anti-Coagulant and Fibrinolytic Activity During the Perioperative Period of Artificial Joint Replacement

目的 评估全关节置术患者围术期抗凝及纤溶活性的变化。方法 238例(男性64例,女性174例,年龄57.8±7.0岁)于2022年3月至2022年12月期间在我院矫形骨科接受全关节置换术的患者(全膝关节置换术患者96例,全髋关节置换术患者142例),观察其在术前、术后24h及72h血浆抗凝血酶Ⅲ(antithrombin Ⅲ,AT Ⅲ)、组织因子途径抑制物(tissue factor pathway inhibitor, TFPI)、组织型纤溶酶原活化物(tissue plasminogen activator, t-PA)和纤溶酶原活化物抑制物-1(plasminogen activator inhibitor-1,PAI-1)的水平变化。结果 (1)血浆AT-Ⅲ水平术后72h之内呈进行性升高,术后24h与72h分别较术前升高16.17%及69.43%,差异具有统计学意义(P<0.05)。(2)血浆TFPI水平术后72h之内呈进行性升高,术后24h与72h分别较术前升高20.78%及58.16%,差异具有统计学意义(P<0.05)。(3)血浆t-PA水平术后72h之内亦呈进行性升高,术后24h与72h分别较术前升高24.60%及41.47%,差异具有统计学意义(P<0.05)。(4)血浆PAI-1水平术后72h之内进行性下降,术后24h与72h分别较术前下降15.51%及41.14%,差异具有统计学意义(P<0.05)。结论 人工全关节置换术患者围术期抗凝及纤溶活性进行性增强。

Objective To evaluate changes of anti-coagulant and fibrinolytic activity during the perioperative period of artificial joint replacement.Methods 238 cases(64 male,174 women,age distribution 57.8±7.0 years)of patients underwent total joint replacement in our Orthopaedic Department from March,2022 to December,2022(96 patients with total knee replacement,142 patients with total hip replacement)were selected for the study.Levels of plasma AT III,TFPI,t-PA and PAI-1 were compared among before,postoperative 24 hours and 72 hours.Results(1)Plasma AT III concentration increased gradually within 72 hours after surgery.The postoperative hours 24 hours and 72 hours were 16.17%and 69.43%higher than the preoperative period(P<0.05).(2)Plasma TFPI concentration increased gradually within 72 hours after surgery.The postoperative hours 24 hours and 72 hours were 20.78%and 58.16%higher than the preoperative period(P<0.05).(3)Plasma t-PA concentrations also increased gradually within 72 hours after surgery.The postoperative hours 24 hours and 72 hours were 24.60%and 41.47%higher than the preoperative period(P<0.05).(4)Plasma PAI-1 concentration decreased progressively within 72 hours after surgery.The concentration of postoperative hours 24 hours and 72 hours were down 24.60%and 41.47%,compared with the preoperative period(P<0.05).Conclusion The anti-coagulant and fibrinolytic activity are progressively increased during the perioperative period of artificial joint replacement.