CAJ | 학술논문

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UTI 5000 U/kg；Uc组术毕于镇痛泵中另加入UTI 10000 U/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12 h起口服利伐沙班抗凝治疗。于术前（T1）、术毕即刻（T2）、术后12 h（T3）、24 h（T4）、48 h（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24 h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12 h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。
목적탐토지속수주오사타정（UTI）연합리벌사반대골과대수술환자응혈공능적영향。방법택기행인공관관절치환술、고골조륭간골절내고정술환자45례，수궤분위UTI지속수주조（Uc조）、UTI단차급약조（Us조）화대조조（C조）。Uc여Us조술전급여UTI 5000 U/kg；Uc조술필우진통빙중령가입UTI 10000 U/kg，지속빙주；C조술전급여등량생리염수。술후균급여정맥자공진통，우술필12 h기구복리벌사반항응치료。우술전（T1）、술필즉각（T2）、술후12 h（T3）、24 h（T4）、48 h（T5）5개시점측정홍세포비용（HCT）、응혈매시간（TT）、섬유단백원함량（FIB）、응혈매원시간（PT）화부분활화응혈매원시간（APTT）。결과여술전상비，C조화Us조TT우술후정하강추세（P<0.05），FIB、PT、APTT우술후24 h기현저증가（P<0.05）；Uc조TT우술후각시점무명현변화（P>0.05），PT、APTT교C조제조12 h증가（P<0.05）；각시점불동조적FIB차이무통계학의의（P>0.05）。결론위술기지속수주UTI연합리벌사반가개선골과대수술환자적고응상태，차사용안전。
Objective To explore the effect of ulinastatin (UTI) continuous infusion combined rivaroxaban on coagu-lation 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 (T1), 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 signifi-cantly 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-tive period, ulinastatin continuous infusion combined rivaroxaban can improve the hypercoagulable state in patients undergo-ing major orthopedic surgery, and safe to use.