急性非等容血液稀释对高龄全髋关节置换术患者围术期血小板活化功能的影响

发布时间：2018-08-04 14:33

【摘要】：背景及意义人工全髋关节置换术是最近几年来发展较快的一项新的矫形手术,可有效减缓高龄病人的痛苦,提高肢体功能状况,改善生活品质。但全髋关节置换术创伤大、出血多,且因为老年人生理机能减退或患高粘滞血症,易并发深静脉血栓(deep vein thrombosis, DVT)。因此了解血栓形成的机制并积极预防和治疗血栓性疾病已经成为十分迫切的课题。血栓形成涉及到血管内皮细胞、血小板、凝血和纤维系统等环节。在许多环节中,血小板的活化、黏附和聚集,不管是在早期生理止血还是在病理的血栓形成过程当中,都起着重要作用。近年来,血小板活化释放的主要分子标志物PAC-1和CD62P愈来愈引起关注。为减少异体输血和预防DVT等并发症的产生,急性非等容血液稀释(ANIH)等血液保护措施已普遍应用于临床,但对其实验室研究大多是对手术患者出血量、输异体血量、血液流变学、凝血功能等方面常规指标的观察,缺乏对凝血与纤溶系统全面的动态的观察,也缺乏对高龄患者的特殊性方面的研究,而对血小板活化功能影响的报道也较少。本研究拟动态观测ANIH对高龄全髋关节置换术患者围手术期血小板活化标记物PAC-1、CD62P及凝血功能指标D二聚体(DD)的影响,探讨ANIH对预防高龄全髋关节置换术患者围手术期血栓形成的作用,为高龄全髋关节置换术患者围手术期血栓形成初期诊断和治疗提供根据。目的观测急性非等容血液稀释(acute non-isovolemic hemodilution, ANIH)对高龄全髋关节置换术患者围手术期血小板活化功能标志物纤维蛋白原受体(血小板激活复合物,platelet activation complement-1, PAC-1)、P-选择素(P-selectin, CD62P)和D-二聚体(DD)的影响。方法选择行高龄全髋关节置换术患者40例,随机分为常规处理对照组和ANIH组;检测患者在麻醉诱导前、ANIH后30min、术毕、术后1d和术后3d静脉血CD62P、PAC-1、PLT和DD水平。结果与常规处理对照组比较,ANIH组患者麻醉诱导前PAC-1、CD62P、PLT和DD差异均无统计学意义(t均0.5,P均0.05)；ANIH后30min、术毕和术后1d PAC-1和CD62P水平均下降(t均2.5,P均0.05)；术后3d PAC-1水平降低(t=2.77, P0.05), PLT水平升高(t=2.68, P0.05), CD62P水平变化不显著(t=0.73,P0.05); DD在术后1d和3d水平下降(t=11.12、11.67,P0.05). ANIH患者组内各时间点与麻醉诱导前比较,ANIH后30min PAC-1和PLT水平降低(t=2.27、19.30,P0.05),CD62P和DD水平升高(t=10.28,8.11,P0.05)；术毕PAC-1、CD62P和DD水平均升高(t分别为4.31、5.86、19.70,P0.05)且PLT水平下降(t=18.26,P0.05)；术后1d PAC-1、CD62P和DD水平均升高(t分别为2.82、5.12、15.37,P0.05)且PLT水平下降(t=13.26,P0.05)；术后3d PAC-1和PLT水平下降(t分别为2.15、14.67,P0.05),CD62P水平升高,但无显著性差异(t=1.27,P0.05)和DD水平升高(t=13.30,P0.05)。结论术前行ANIH能抑制高龄全髋关节置换术患者围手术期血小板过分活化,对抑制血栓形成有一定作用。
[Abstract]:Background and significance Total hip arthroplasty is a new orthopedic surgery developed rapidly in recent years. It can effectively relieve the pain of the elderly patients improve the limb function and improve the quality of life. But the total hip arthroplasty has great trauma and bleeding, and it is easy to be complicated with deep venous thrombosis (deep vein thrombosis, DVT).) because of the decline of physiological function or hyperviscosity in the elderly. Therefore, understanding the mechanism of thrombosis and actively preventing and treating thrombotic diseases has become an urgent issue. Thrombosis involves vascular endothelial cells, platelets, coagulation and fiber systems. Activation, adhesion and aggregation of platelets play an important role in early physiological hemostasis and pathological thrombogenesis. In recent years, PAC-1 and CD62P, the main molecular markers of platelet activation and release, have attracted more and more attention. In order to reduce blood transfusion and prevent complications such as DVT, acute hemodilution of (ANIH) and other blood protection measures have been widely used in clinical practice, but most of the laboratory studies on blood loss, allogeneic blood volume, hemorheology, and so on. The observation of coagulation function is lack of comprehensive dynamic observation of coagulation and fibrinolysis system, lack of study on the particularity of elderly patients, and there are few reports on the effect of platelet activation function. The purpose of this study was to investigate the effects of ANIH on platelet activation marker PAC-1CD62P and D-dimer (DD) in elderly patients undergoing total hip arthroplasty. To explore the effect of ANIH on the prevention of perioperative thrombosis in elderly patients with total hip arthroplasty, and to provide the basis for the early diagnosis and treatment of perioperative thrombosis in elderly patients with total hip arthroplasty. Objective to observe the P- selection of platelet activation complement-1 (PAC-1) in elderly patients undergoing total hip arthroplasty with acute non-isovolemic hemodilution (acute non-isovolemic hemodilution, ANIH). Effects of P-selectin (CD62P) and D-dimer (DD). Methods Forty elderly patients undergoing total hip replacement were randomly divided into two groups: control group and ANIH group. The levels of CD62PnPAC-1PLT and DD were measured 30 minutes before anesthesia induction, 1 day after operation, 1 day after operation and 3 days after operation. Results there was no significant difference in PAC-1 and DD between ANIH group and ANIH group before anesthesia induction (t = 0.5, P 0.05). The levels of PAC-1 and CD62P in ANIH group decreased 30 minutes after operation and 1 day after operation (t = 2.5, P < 0.05). On the 3rd day after operation, the level of PAC-1 decreased (tn 2.77, P0.05), PLT increased, P0.05), but the level of CD62P did not change significantly (t0. 73); DD decreased on the 1st day and 3rd day after operation (t 11.12? 11.67? P 0.05). The levels of CD62P and DD in ANIH group were significantly lower than those before anesthesia induction (t = 2.27 卤19.30), and the levels of CD62P and DD in ANIH group were higher than those before anesthesia induction (t = 4.31, 5.86, 19.70, respectively), and the PLT level was decreased (t = 18.26, P 0.05), and the levels of CD62P and DD in ANIH group were increased (t = 4.31, 5.86, 19.70, respectively), and the levels of CD62P and DD in ANIH group were significantly higher than those before anesthesia induction (t = 10.28, P < 0.05). On the 1st day after operation, the levels of CD62P and DD increased (t = 2.82) and PLT decreased (t = 13.26), and the levels of PAC-1 and PLT decreased (t = 2.15 ~ 14.67), but there was no significant difference (t = 1.27) and DD (t = 13.30). Conclusion preoperative ANIH can inhibit platelet overactivation in elderly patients with total hip arthroplasty during perioperative period, and can inhibit thrombosis to some extent.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4;R446.1

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