天津医药

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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

于熙   

  1. 天津医科大学第二医院麻醉科
  • 收稿日期:2012-08-09 修回日期:2012-11-08 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 于熙

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

YUXi   

  1. Department of Anesthesiology, The Second Affiliated Hospital of Tianjin Medical University, Tianjin 300211, China
  • Received:2012-08-09 Revised:2012-11-08 Published:2013-07-15 Online:2013-07-15
  • Contact: YUXi

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摘要：

【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。 

关键词: 乌司他丁, 利伐沙班, 凝血实验, 骨科手术, 持续输注

Abstract: Objective    To explore the effect of ulinastatin 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 the patients received patient-controlled intravenous analgesia (PCIA) after the operation and took rivaroxaban orally 12 hours after the operation. Ulinastatin (5000 U/kg) was given intravenously to both group Uc and Us preoperatively, group C given isometric normal saline, group Uc pumped UTI continuous intravenously at the end of surgery(10000 U/kg) to 48 hours through PCIA pump. Hematocrit(HCT), plasma prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT) , fibrinogen(FIB) were normally tested before surgery(T1), at the end of the surgery(T2), 12 hours(T3), 24 hours(T4), 48 hours(T5) after the surgery. Results     Compared with T1, TT had a downward tendency after the operation in group C and Us (P <0.05), and FIB ,PT ,APTT were significantly increased from 24 hours after the surgery (P <0.05); In group Uc, the changes of TT showed an steady tendency after the operation (P >0.05), PT and APTT became extended 12 hours earlier than group C (P <0.05), there was no substantial difference in the levels of FIB between the three groups in the postoperative period (P >0.05). Conclusion    During the perioperative period, ulinastatin continuous infusion combined rivaroxaban can improve the hypercoagulable state in patients undergoing major orthopedic surgery,and the clinical efficacy is safe.

Key words: Ulinastatin, Rivaroxaban, blood coagulation tests, major orthopedic surgery