摘要【目的】探究髋关节置换术后乌司他丁联合拜瑞妥对患者凝血功能的影响。【方法】选取2012年2月至2014年3月来本院就诊的需行择期髋关节置换术患者102例，随机将患者分为治疗组及对照组，每组51例。对照组：口服拜瑞妥联合其他常规治疗措施进行治疗；治疗组：在对照组治疗方案的基础上加用静脉滴注乌司他丁进行治疗。检测比较两组患者各项凝血指标及临床表现。【结果】治疗前两组患者的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体（D-Dimer ，DD）、C反应蛋白（C-reactive protein ，CRP）及血栓素B2（thromboxane B2，TXB2）比较差异无统计学意义（ P ＞0．05）；术后2 d治疗组患者的PT、APTT 及TT 明显高于对照组，治疗组的DD及FIB明显低于对照组，差异有统计学意义（ P ＜0．05）；术后5 d内治疗组患者的TXB2（0．26±0．10）μg/L、CRP（33．81±12．48）mg/L、总引流量（349．86±119．75）m L及住院时间（7．26±2．85）d分别均低于对照组（0．31±0．14）μg/L ，（39．42±14．79）m g/L ，（417．03±134．72）m L ，（9．35±3．86）d ，其差异均有显著性（ P＜0．05）。治疗组患者治疗过程中并发感染、切口大量渗血、血肌酐升高及血尿素升高例数明显低于对照组；治疗组患者出现恶心的例数6（11．76％）明显高于对照组0（0．00％），差异均有统计学意义（ P ＜0．05）。【结论】乌司他丁联合拜瑞妥可明显改善髋关节置换术后患者的高凝状态，降低深静脉血栓发生率，且对促进患者的切口愈合及免疫力恢复具有一定作用。
Abstract：Objective To explore the effect of ulinastatin combined with Xarelto on coagulation function of patients after hip replacement .[Methods] Totally 102 patients undergoing elective hip replacement in our hospital from Feb .2012 to March 2014 were chosen .According to the stratified randomization method ,all patients were divided into treatment group and control group with 51 in each .The control group received oral Xarelto combined with other conventional treatment ,while the treat-ment group received ulinastatin on the basis of the treatment regimen of the control group .The coagulation parameters and clin-ical manifestations were compared between two groups .[Results]There was no significant difference in prothrombin time(PT) , activated partial thromboplastin time(APTT) ,thrombin time(TT) ,fibrinogen(FIB) ,D-dimer(DD) ,C-reactive protein(CRP) and thromboxane B2(TXB2) between two groups before treatment( P>0 .05) .The PT ,APTT and TT in treatment group 2d after treatment were obviously higher than those of control group ,but DD and FIB in treatment group were obviously lower than those in control group ,and there was significant difference( P<0 .05) .The TXB2[(0 .26 ± 0 .10)μg/L] ,CRP[(33 .81 ± 12 .48)mg/L] ,total drainage volume[(349 .86 ± 119 .75)mL] and hospital stay [(7 .26 ± 2 .85)d] in treatment group 5d after operation were lower than those in control group [(0 .31 ± 0 .14)μg/L ,(39 .42 ± 14 .79)mg/L ,(417 .03 ± 134 .72)mL and (9 .35 ± 3 .86)d]( P <0 .05) .The patients with concurrent infection ,large bleeding of incision ,elevated serum creatinine and blood urea in treatment group were obviously less than that of control group .The patients with nausea(6 ,11 .76% ) in treat-ment group was obviously more than that of treatment group (0 ,0 .00% ) ,and there was significant difference( P <0 .05) .[Conclusion] Ulinastatin combined with Xarelto can significantly improve the hypercoagulable state of patients after hip re-placement and reduce the incidence of deep vein thrombosis ,and plays an important role in promoting wound healing and immu-nity recovery .
基金资助:国家自然科学基金(81101381)
引用本文:
张琪%朱俊峰. 髋关节置换术后乌司他丁联合拜瑞妥对患者凝血功能的影响[J]. 医学临床研究, 2014, 31(7): 1252-1258.
ZHANG Qi%ZHU Jun-feng. Effect of Ulinastatin Combined with Xarelto on Coagulation Function of Patients after Hip Replacement. 医学临床研究, 2014, 31(7): 1252-1258.
2014, Vol. 31 
