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目的 探讨参附注射液对全髋关节置换术的老年患者围术期凝血功能、血浆D-二聚体和P-选择素浓度的影响.方法 择期行全髋关节置换术老年患者24例,随机分为参附注射液组(S组)与对照组(N组),每组12例.术前两组患者一般情况差异无统计学意义.S组:麻醉成功后予参附注射液0.2 ml/kg经外周静脉缓慢注射,继以0.8 ml·kg-1·h-1持续注入至手术结束;N组则以生理盐水替代.术后均予患者自控镇痛(PCEA).检测术前(T0)、手术结束(T1)及术后24 h(T2)血浆D-二聚体、P-选择素浓度和出凝血时间.结果 两组患者手术时间、术中输液差异无统计学意义;两组患者凝血功能差异无统计学意义(P＞0.05);血浆D-二聚体:T1,S组明显低于N组(325±30)vs(351±39),P＜0.05;T2两组均明显上升,与T0、T1比较差异有统计学意义(P＜0.01);血浆P-选择素:T1,N组明显上升(P＜0.05),而S组无明显上升,与N组比较S组明显低(6.2±1.8)vs(19.4±1.4),P＜0.05;T2两组均明显上升,与T0、T1比较差异有统计学意义(P＜0.01).结论 全髋关节置换术的老年患者围术期血浆D-二聚体浓度和P-选择素浓度明显升高;参附注射液可降低术中血浆D-二聚体浓度,抑制血浆P-选择素浓度的升高,可抑制由于手术创伤引起的机体的凝血和纤溶的活跃,有保护血管内皮细胞和抑制血小板活化等作用,对凝血功能无明显的影响.

Objective To investigate the effects of SF injection on coagulation function, p-selectin and D-dimer concentrations in plasma of elderly patients undergoing total hip replacemen(THR). Methods Twenty-four ASA Ⅱ/ Ⅲ patients aged 65 to 85 were divided equally into two groups (n = 12). In Group S, SF injection was administered by peripheral intravenous infusion at initially 0. 2 ml/kg and then 0. 8 ml(kg/h) until the end of operations. In Group N, normal saline was administered similarly. All the patients were given patient-controlled epidural analgesia (PCEA) after operations. Blood samples were taken before operations ( T0 ), immediately post-operation ( T1 ) and 24 h post-operation to detect the levels of p-selectin, D-dimer, blood platelet count and clotting time at all time points. Results The concentrations of p-selectin and D-dimer in Group N increased at T1 and T2 while those in Group S decreased at T1 (P ＜0. 05). Compared with Group N, they were significantly lower in Group S ( P ＜ 0. 05 ). There was no significant difference at T2 between two groups. Conclusion The plasma concentrations of p-selectin and Ddimer increase obviously in elderly THR patients. SF injection can decrease the plasma concentrations of pselectin and D-dimer in patients during surgery. Thus it may protect the vascular endothelial cells and attenuate the activation of platelet and fibrinolysis.