抑肽酶对脑肿瘤手术患者凝血功能及血清炎性介质水平的影响

Effect of aprotinin on coagulation function and serum inflammatory mediator level in patients undergoing surgery for brain tumors

目的探讨抑肽酶对脑肿瘤手术患者凝血功能及血清炎性介质水平的影响。方法选取2016年3月至2018年3月间上海市浦东医院收治的58例脑肿瘤手术患者,采用随机数表法分为观察组和对照组,每组29例。观察组患者于术前12h～术后24h静脉注射加入抑肽酶的林格氏液,对照组患者注射等容量格林氏液,比较两组患者在诱导前(T1)、术中(T2)和术后24h(T3)的凝血指标和血清炎性介质水平。结果观察组患者T2期凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血速率(CR)、活化凝血时间(ACT)和血小板功能(PF)与T1期比较差异均有统计学意义(均P <0. 05);对照组患者T2期PT、FIB、CR、ACT和PF与T1期比较差异均有统计学意义(均P <0. 05)。观察组患者T2期APTT和PF水平均高于对照组,差异均有统计学意义(均P <0. 05)。T1期,两组患者白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0. 05)。T3期,两组患者IL-6和TNF-α水平均较术前升高,且观察组T2、T3期IL-6和TNF-α水平均低于对照组,差异均有统计学意义(均P <0. 05)。观察组患者出血量少于对照组,脑水肿程度轻于对照组,差异均有统计学意义(均P <0. 05)。结论脑肿瘤手术患者使用抑肽酶药物可保护血小板功能,延长凝血时间,减少炎性介质的释放,对患者凝血功能和炎性抑制都有较好影响,值得临床推广。

Objective To investigate the effect of aprotinin on blood coagulation function and serum inflammatory mediator level in patients undergoing surgery for brain tumor. Methods A total of 58 patients who underwent surgery for brain tumors at Shanghai Pudong Hospital from March 2016 to March 2018 were selected as subjects. The random number table method was used and the patients were divided into an observation group and a control group with 29 patients in each group. In the observation group,Ringer’s solution with aprotinin was intravenously injected from 12 h before the surgery to 24 h after the operation,and the control group was injected with the same volume of Ringer’s solution. The differences in coagulation parameters and serum inflammatory mediator levels between the two groups before induction( T1),intraoperation( T2),and 24 h postoperation( T3) were observed. Results The prothrombin time( PT),activated partial thromboplastin time( APTT),fibrinogen( FIB),coagulation rate( CR),activated coagulation time( ACT) and platelet function( PF) in the observation group were significantly higher or lower in T2 phase than in T1 phase( all P < 0. 05). The PT,FIB,CR,ACT and PF in the control group were significantly higher or lower in T2 phase than in T1 phase.( all P < 0. 05). In T2 phase,the levels of APTT and PF in the observation group were significantly higher than in the control group( all P < 0. 05). There was no significant difference in the levels of IL-6 and TNF-α between the two groups in T1 phase( P > 0. 05). The levels of IL-6 and TNF-α in the two groups were significantly higher than in the T1 phase( all P < 0. 05). The levels of IL-6 and TNF-α in the T2 and T3 phases in the observation group were significantly higher than in the control group( all P < 0. 05). The amount of bleeding was significantly lower in the observation group than in the control group( P < 0. 05),and the degree of cerebral edema was significantly milder than in the control group( all P <0. 05). Conclusion The use of aprotinin drugs in patients undergoing surgery for brain tumor can protect platelet function,prolong clotting time,reduce the release of inflammatory mediators,and have a good effect on patients’ coagulation function and inflammatory inhibition,which is worthy of clinical promotion.