乌斯他丁对老年髋关节置换术后血栓素B_2水平和深静脉血栓形成的影响

目的：探讨不同剂量乌司他丁（Uti）对老年髋关节置换患者术后血栓素B2（TXB2）水平及深静脉血栓形成的影响。方法：选择ASAⅠ～Ⅱ级择期行髋关节置换术患者80例,年龄65～85岁,随机分为4组（n=20）。U1组：Uti5000U/kg;U2组：Uti1万U/kg;U3组：Uti2万U/kg;C组：同体积0.9%NaCl溶液对照。分别于术前（T1）、术毕（T2）、术后1d（T3）、2d（T4）、3d（T5）5个时间点抽血检测TXB2水平,并于术后3天应用彩色多普勒超声检查下肢血栓形成情况。结果：与T1比较,C组T2-5时,U1组T2-4时,U2,U3组T2时TXB2水平均升高（P〈0.01）;与C组相比,U1组T2-3时、U2,U3组T2-4时TXB2水平降低（P〈0.01）;与U1组比较,U2,U3组T2-4时点TXB2水平降低（P〈0.01）。C组术后3天有8例发生深静脉血栓（40%）,U1组有2例（10%）,U2,U3组未发生。结论：Uti具有剂量依赖性抑制TXB2释放的作用,能在一定程度上预防髋关节置换术后深静脉血栓形成。

Effect of ulinastatin on thromboxane B_2 and deep vein thrombosis in elderly patients after hip joint replacement

Objective To determine the effect of ulinastatin on plasma thromboxane B2 and deep vein thrombosis（DVT） in elderly patients after hip joint replacement.Methods Eighty ASAⅠ-Ⅱpatients aged 65-81 years undergoing hip joint replacement were randomly divided into 4 groups （n=20）： Group U1 （ulinastatin 5 000 U/kg）;Group U2 （ulinastatin 10 000 U/kg）; Group U3 （ulinastatin 20 000 U/kg）; and Group C （the same volume of saline as control）.The blood samples were collected at 5 time points： preoperation （T1）, immediately after the operation （T2）, 1 d （T3）, 2 d （T4） and 3 d after the operation （T5）, respectively. Thromboxane B2 was detected, and DVT was also examined through color Doppler ultrasonography 3 d after the operation.Results Compared with T1, the level of thromboxane B2 significantly increased in Group C at T2-5, in Group U1 at T2-4, in Group U2 and U3 at T2 （P0.01）. Compared with Group C, the concentration of thromboxane B2 decreased in Group U1 at T2-3, in Group U2 and U3 at T2-4 （P0.01）.Compared with Group U1, thromboxane B2 significantly decreased in Group U2 and U3 at T2-4 （P0.01）.The incidence rate of DVT was 40% in Group C, 10% in Group U1. There was no incidence of DVT in the Group U2 and U3 （P0.05）.Conclusion Ulinastatin can inhibit blood thromboxane B2 level in dose dependent manner and prevent DVT in elderly patients after hip joint replacement.