CAJ | 학술논문

目的比较乌司他丁(Uti)与低分子量肝素(Lmwh)对髋关节置换患者围术期凝血功能和深静脉血栓(DVT)形成的影响.方法 2010年3月至12月选择美国麻醉医师协会(ASA)Ⅰ～Ⅱ级择期行髋关节置换术患者150例,年龄65～85岁,平均72.5岁.随机分成生理盐水(NS)对照组(C组)、Uti组(U组)和Lmwh组(L组),每组50例.U组在术前1 d、术中、术后第1、2、3天缓慢静脉注射Uti 1万U/kg;C组只给予等量NS;L组术前1 d、术后第1、2、3天腹壁皮下注射Lmwh3200 U/d,但手术日及术中不给药.分别于术前(T0)、术毕(T1)、术后1 d(T2)、2 d(T3)、3 d(T4)5个时间点抽取静脉血标本,以凝血弹性描记仪(TEG)检测各组患者的凝血功能;术后3 d以彩色超声(CDFI)检查患者DVT的形成.结果 (1)C组患者处于相对高凝状态,其中术后1 d达最高峰,至术后3 d则有恢复趋势;在T1、T2、T3各观察时间点中:与C组相比,U组、L组中的凝血反应时间、凝血形成时间值均延长、凝血形成速率、凝血最终强度、凝血综合指数均减小(P＜0.01).经Uti及Lmwh处理,患者呈相对非高凝状态;(2)L组患者术中出血量、术后1 d引流量大于U组、C组;(3)术后3 d,C组、U组DVT发病数分别为20例(发病率为40%)及1例(发病率为2%),L组患者无DVT发生.结论 Uti、Lmwh均能有效改善髋关节置换患者围术期高凝状态,降低术后DVT的发病率.但Lmwh一定程度上增加术中与术后手术部位出血量.
목적 비교오사타정(Uti)여저분자량간소(Lmwh)대관관절치환환자위술기응혈공능화심정맥혈전(DVT)형성적영향.방법 2010년3월지12월선택미국마취의사협회(ASA)Ⅰ～Ⅱ급택기행관관절치환술환자150례,년령65～85세,평균72.5세.수궤분성생리염수(NS)대조조(C조)、Uti조(U조)화Lmwh조(L조),매조50례.U조재술전1 d、술중、술후제1、2、3천완만정맥주사Uti 1만U/kg;C조지급여등량NS;L조술전1 d、술후제1、2、3천복벽피하주사Lmwh3200 U/d,단수술일급술중불급약.분별우술전(T0)、술필(T1)、술후1 d(T2)、2 d(T3)、3 d(T4)5개시간점추취정맥혈표본,이응혈탄성묘기의(TEG)검측각조환자적응혈공능;술후3 d이채색초성(CDFI)검사환자DVT적형성.결과 (1)C조환자처우상대고응상태,기중술후1 d체최고봉,지술후3 d칙유회복추세;재T1、T2、T3각관찰시간점중:여C조상비,U조、L조중적응혈반응시간、응혈형성시간치균연장、응혈형성속솔、응혈최종강도、응혈종합지수균감소(P＜0.01).경Uti급Lmwh처리,환자정상대비고응상태;(2)L조환자술중출혈량、술후1 d인류량대우U조、C조;(3)술후3 d,C조、U조DVT발병수분별위20례(발병솔위40%)급1례(발병솔위2%),L조환자무DVT발생.결론 Uti、Lmwh균능유효개선관관절치환환자위술기고응상태,강저술후DVT적발병솔.단Lmwh일정정도상증가술중여술후수술부위출혈량.
Objective To investigate the effects of ulinastatin (Uti) and low-molecular-weight heparin (Lmwh)on coagulation function and deep vein thrombosis(DVT) in patients undergoing hip joint replacement. Methods From March to December 2010 150 ASA Ⅰ - Ⅱ patients with average age of 72.5(65-85) years undergoing hip joint replacement were randomly divided into 3 groups (n = 50 each): normal saline (NS)control group (Group C), Uti group(Group U) and Lmwh group (Group L). Group U received intravenous infusion of ulinastatin(10000 U/kg) at preoperative, perioperative and after operation 1,2 and 3 d, respectively. Group C received the same volume of NS instead of Uti. Group L were injected Lmwh subcutaneously (3200 U/d) at preoperative, after operation 1, 2 and 3 d. Blood samples were taken before operation (T0), at the end of surgery(T1), 1 d(T2) ,2 d(T3) and 3 d(T4) after operation for determination the values of R, K, α angle, MA and CI, using thrombeelastography, and the DVT were also examined through color Doppler ultrasonography at 3 d after operation. Results Compared with T0, R, K were shorter, α angle, MA and CI were larger in group C, the values at T2 were up to the peak then declined at T4.Compared with group C, the value of R, K were larger, the value of α angle, MA and CI were shorter in group U and group L. The DVT checked by ultrasonography were found in 20 cases in group C, 1 case in group U, and zero case in group L. The differences were no statistically significant between group U and group L. Conclusion Intravenous infusion of Uti during the period of operation can correct the hypercoagulability of blood and decrease the incidence of DVT after operation.