乌司他丁持续输注联合利伐沙班对骨科大手术患者凝血功能的影响  

The Effect of Ulinastatin Continuous Infusion Combined Rivaroxaban on Coagulation Function in Patients Undergoing Major Orthopedic Surgery

作　　者：于熙[1] 吕国义[1] 田毅[2] 田国刚[2] 

机构地区：[1]天津医科大学第二医院麻醉科,300211 [2]中南大学湘雅医学院海口医院麻醉科

出　　处：《天津医药》2013年第7期692-695,共4页Tianjin Medical Journal

基　　金：2010年海南省卫生厅科研立项课题项目(项目编号:琼卫2010-83)

摘　　要：目的探讨持续输注乌司他丁(UTI)联合利伐沙班对骨科大手术患者凝血功能的影响。方法择期行人工髋关节置换术、股骨粗隆间骨折内固定术患者45例,随机分为UTI持续输注组(Uc组)、UTI单次给药组(Us组)和对照组(C组)。Uc与Us组术前给予UTI5000U/kg;Uc组术毕于镇痛泵中另加入UTI10000U/kg,持续泵注;C组术前给予等量生理盐水。术后均给予静脉自控镇痛,于术毕12h起口服利伐沙班抗凝治疗。于术前(T1)、术毕即刻(T2)、术后12h(T3)、24h(T4)、48h(T5)5个时点测定红细胞比容(HCT)、凝血酶时间(TT)、纤维蛋白原含量(FIB)、凝血酶原时间(PT)和部分活化凝血酶原时间(APTT)。结果与术前相比,C组和Us组TT于术后呈下降趋势(P<0.05),FIB、PT、APTT于术后24h起显著增加(P<0.05);Uc组TT于术后各时点无明显变化(P>0.05),PT、APTT较C组提早12h增加(P<0.05);各时点不同组的FIB差异无统计学意义(P>0.05)。结论围术期持续输注UTI联合利伐沙班可改善骨科大手术患者的高凝状态,且使用安全。Objective To explore the effect of ulinastatin （UTI） continuous infusion combined rivaroxaban on coagulation function in patients undergoing major orthopedic surgery. Methods Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups： ulinastatin continuous infusion （Uc） group, ulinastatin single injection （Us） group and control （C） group. All patients received patient-controlled intravenous analgesia （PCIA） after operation, and took rivaroxaban orally 12 hours after operation. Ulinastatin （5 000 U/kg） was given intravenously to both Uc and Us groups preop eratively. Group C was given isometric normal saline, group Uc was pumped UTI continuous intravenously at the end of sur- gery （10 000 U/kg） to 48 hours through PCIA pump. The values of hematocrit （HCT）, thrombin time （TT）, fibrinogen （FIB）, plasma prothrombin time （PT） and activated partial thromboplastin time （APTT） were normally tested before surgery （T）, at the end of the surgery （T2）, 12 hours （T3）, 24 hours （T4） and 48 hours （T5） after surgery. Results Compared with T1, there was a downward tendency in TT after operation in group C and group Us （P 〈 0.05）. The values of FIB, PT and APTT were significantly increased from 24-hour after surgery （P 〈 0.05）. In group Uc, there were no significant changes in TT after operation （P 〉 0.05）. Values of PT and APTT increased 12 hours earlier than those of group C （P 〈 0.05）. There was no substantial dif- ference in the level of FIB between three groups in the postoperative period （P 〉 0.05）. Conclusion During the periopera- tire period, ulinastatin continuous infusion combined rivaroxaban can improve the hypercoagulable state in patients undergo- ing major orthopedic surgery, and safe to use.

关 键 词：乌司他丁 利伐沙班 凝血实验 骨科手术 持续输注 

分 类 号：R687[医药卫生—骨科学]