疏血通对髋关节置换术后患者血栓调节蛋白的影响及意义

A clinical study on the changes of plasma thrombomodulin in the patients after hip replacement receiving treatment of shuxuetong complex(疏血通)

目的 评估疏血通对髋关节置换手术患者术后血栓调节蛋白 (TM)的影响。方法 本科 2 0 0 2年 7月～ 2 0 0 3年 4月髋关节置换手术共 2 5例 ,其中男 1 3例 ,女 1 2例 ,年龄 5 2～ 74岁 ,平均 (6 4 .6± 1 3.2 )岁。根据入院时间单双日分为治疗组 (1 4例 )和对照组 (1 1例 ) ,术前 3d开始分别采用疏血通和低分子肝素治疗共 1 4d ,于用药前、术前 1d、术后 1、3、7、1 0d采用酶联免疫双抗体夹心法 (ELISA)测定血浆血栓调节蛋白 ,用酶联免疫检测仪直接测定其含量 ,所有患者均行静脉造影检查。结果 疏血通治疗组和低分子肝素治疗组DVT发病率分别为 2 3.1 %、2 7.7% ,术前对照组和治疗组相比TM无显著差异 ,术后各时间点 ,对照组和治疗组相比TM有显著差异 (P <0 .0 5 )。结论 PTM作为内皮细胞损伤的标志物 ,它能反映内皮细胞的损伤程度 ,疏血通在预防和治疗髋关节术后静脉血栓形成中 ,不仅有抗凝、激活纤溶的作用 。

Objective To investigate the change of plasma thrombomudolin (PTM) in the patients after hip replacement receiving treatment of Shuxuetong complex.Methods In 25 consecutive patients undergoing hip replacement between July 2002 and April 2003 were randomly divided into treatment group ( n =14) and control group ( n =11).Treatment group administrated Shuxuetong complex and control group adjusted dose subcutaneous low molecular heparin calcium.At the day before administration,the day of preoperative and the 1st,3rd,7th,10th day of postoperative period,the pTM levels were detected by ELISA.Venography was used to diagnose deep venous thromboses(DVT). Results Three of 14(21.4%) patients had venographically evident DVT in the treatment group and 3 of 11 (27.3%) in control group.AT the difference time points post operation,there were significantly differences between the control group and treatment group ( P <0.05).Conclusions As the marker of injury of endothelial cell,pTM level can reflect the degree of endothelial injury.The prophylaxis and therapeutic effect of shuxuteong complex are not only anticoagulation and activation of fibrinolysis but also protection of endothelial cell in patients undergoing replacement of hip.