目的 探討前列地爾聯(lián)合低分子肝素改善止血帶加壓下行雙側(cè)膝關(guān)節(jié)置換術(shù)(TKA)患者術(shù)后凝血功能、下肢深靜脈血栓(DVT)形成的療效觀察。方法 選取2014年1月-2015年2月包頭市第四醫(yī)院收治的擇期硬膜外聯(lián)合蛛網(wǎng)膜下腔阻滯麻醉下行雙側(cè)TKA的患者60例,將患者隨機(jī)分為對照組和治療組,每組30例。對照組患者采用彈力繃帶加壓包扎,并于術(shù)后第1天開始皮下注射低分子肝素6 kU/d,1次/d,直至術(shù)后7 d。治療組患者在對照組基礎(chǔ)上止血帶加壓前靜脈滴入前列地爾注射液10μg,并于術(shù)后24、48、72 h分別靜脈滴入前列地爾注射液10μg。分別在手術(shù)前24 h以及術(shù)后6、24、48、72 h抽取上肢外周靜脈血,檢測凝血功能和血液流變學(xué),術(shù)后行下肢血管超聲檢查血栓形成情況。結(jié)果 術(shù)后6 h兩組活化部分凝血活酶時間(APTT)、凝血酶原時間(PT)與術(shù)前24 h比較明顯減小(P < 0.05),術(shù)后72 h治療組PT高于對照組(P < 0.05);兩組纖維蛋白原(FIB)在術(shù)后24~72 h比術(shù)前24 h明顯增加(P < 0.05);兩組D-二聚體在術(shù)后6~72 h較術(shù)前24 h明顯增加(P < 0.05),其中術(shù)后24、48 h兩組比較,治療組明顯低于對照組(P < 0.05)。術(shù)后48、72 h兩組全血高切相對指數(shù)和全血低切相對指數(shù)與術(shù)前24 h比較明顯增加(P < 0.05),術(shù)后24 h全血高切相對指數(shù)治療組低于對照組(P < 0.05),術(shù)后24~72 h全血低切相對指數(shù)治療組低于對照組(P < 0.05);術(shù)后6~72 h兩組血漿黏度較術(shù)前24 h明顯增加(P < 0.05),其中在術(shù)后24~48 h治療組低于對照組(P < 0.05);術(shù)后6~72 h兩組紅細(xì)胞聚集指數(shù)高于術(shù)前24 h(P < 0.05),其中術(shù)后24~48 h治療組低于對照組。小腿肌間靜脈血栓治療組明顯少于對照組(P < 0.05)。結(jié)論 行雙側(cè)TKA的患者應(yīng)用前列地爾注射液聯(lián)合低分子肝素能夠改善術(shù)后血液高凝狀態(tài)和血液流變學(xué),減緩血栓的形成。

Objective To investigate the effect of alprostadil combined with low molecular weight heparinon on improvement of coagulation function and the incidence of deep vein thrombosis (DVT) after bilateral total knee arthroplasty (TKA) under tourniquet inflation. Methods Patients (60 cases) with epidural anesthesia of The Fourth Hospital of Baotou from January 2014 to February 2015 were randomly divided into control and treatment groups, and each group had 30 cases. All patients received the same combined spinal epidural anesthesia. The patients in the control group iv administered with low molecular weight heparin 6 kU/d at first day after surgery, once daily, and received treatment for 7 d after surgery. The patients in the treatment group were iv administered with Alprostadil Injection10 μg on the basis of control group before tourniquet inflation, and then at 24, 48, and 72 h after surgery, respectively. Peripheral venous bloods from patients were drawn from the upper limbs, and coagulation function and hemorrheology were detected at 24 h before surgery, and 6,24, 48, and 72 h after surgery. Thrombosis in lower extremity vein was detected by ultrasound after surgery. Results Compared with index at 24 h before surgery, APTT and PT in two groups were significantly decreased at 6 h after surgery (P < 0.05), and PT in the treatment group was prolonger than that in the control group at 72 h after surgery (P < 0.05). Compared with index at 24 h before surgery, FIB in two groups was significantly increased from 24 h to 72 h after surgery (P < 0.05). D-dimer in two groups was obviously increased from 6 h to 72 h after surgery compared with index at 24 h before surgery (P < 0.05), and D-dimer in the treatment group was significantly less than that in the control group at 24 and 48 h after surgery (P < 0.05). Compared with index at 24 h before surgery, the whole blood high shear relative index and whole blood low shear relative index in two groups was increased at 48 and 72 h after surgery (P < 0.05). The whole blood high shear relative index in the treatment group was lower than that in the control group at 24 h after surgery (P < 0.05), and whole blood low shear relative index in the treatment group was lower than that in the control group from 24 h to 72 h after surgery (P < 0.05). Plasma viscosities in two groups were obviously increased from 6 h to 72 h after surgery (P < 0.05), and plasma viscosity in the treatment group was lower than that in the control group from 24 h to 48 h after surgery (P < 0.05). Compared with index at 24 h before surgery, red cell assembling index in two groups was increased from 6 h to 72 h after surgery (P < 0.05), and red cell assembling index in the treatment group was lower than that in the control group from 24 h to 48 h after surgery (P < 0.05). The incidence of thrombosis in venous of lower extremity skeletal muscle in the treatment group was less than that in the control group (P < 0.05). Conclusion Alprostadil Injection combined with low molecular weight heparinon can improve hemagglutination state and hemorheology postoperatively and decelerate the formation of thrombosis in patients with epidural anesthesia after TKA under tourniquet inflation.