抑肽酶对脑肿瘤手术患者凝血功能及血清炎性介质水平的影响
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摘要
目的探讨抑肽酶对脑肿瘤手术患者凝血功能及血清炎性介质水平的影响。方法选取2016年3月至2018年3月间上海市浦东医院收治的58例脑肿瘤手术患者,采用随机数表法分为观察组和对照组,每组29例。观察组患者于术前12h～术后24h静脉注射加入抑肽酶的林格氏液,对照组患者注射等容量格林氏液,比较两组患者在诱导前(T1)、术中(T2)和术后24h(T3)的凝血指标和血清炎性介质水平。结果观察组患者T2期凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血速率(CR)、活化凝血时间(ACT)和血小板功能(PF)与T1期比较差异均有统计学意义(均P <0. 05);对照组患者T2期PT、FIB、CR、ACT和PF与T1期比较差异均有统计学意义(均P <0. 05)。观察组患者T2期APTT和PF水平均高于对照组,差异均有统计学意义(均P <0. 05)。T1期,两组患者白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0. 05)。T3期,两组患者IL-6和TNF-α水平均较术前升高,且观察组T2、T3期IL-6和TNF-α水平均低于对照组,差异均有统计学意义(均P <0. 05)。观察组患者出血量少于对照组,脑水肿程度轻于对照组,差异均有统计学意义(均P <0. 05)。结论脑肿瘤手术患者使用抑肽酶药物可保护血小板功能,延长凝血时间,减少炎性介质的释放,对患者凝血功能和炎性抑制都有较好影响,值得临床推广。
Objective To investigate the effect of aprotinin on blood coagulation function and serum inflammatory mediator level in patients undergoing surgery for brain tumor. Methods A total of 58 patients who underwent surgery for brain tumors at Shanghai Pudong Hospital from March 2016 to March 2018 were selected as subjects. The random number table method was used and the patients were divided into an observation group and a control group with 29 patients in each group. In the observation group,Ringer's solution with aprotinin was intravenously injected from 12 h before the surgery to 24 h after the operation,and the control group was injected with the same volume of Ringer's solution. The differences in coagulation parameters and serum inflammatory mediator levels between the two groups before induction( T1),intraoperation( T2),and 24 h postoperation( T3) were observed. Results The prothrombin time( PT),activated partial thromboplastin time( APTT),fibrinogen( FIB),coagulation rate( CR),activated coagulation time( ACT) and platelet function( PF) in the observation group were significantly higher or lower in T2 phase than in T1 phase( all P < 0. 05). The PT,FIB,CR,ACT and PF in the control group were significantly higher or lower in T2 phase than in T1 phase.( all P < 0. 05). In T2 phase,the levels of APTT and PF in the observation group were significantly higher than in the control group( all P < 0. 05). There was no significant difference in the levels of IL-6 and TNF-α between the two groups in T1 phase( P > 0. 05). The levels of IL-6 and TNF-α in the two groups were significantly higher than in the T1 phase( all P < 0. 05). The levels of IL-6 and TNF-α in the T2 and T3 phases in the observation group were significantly higher than in the control group( all P < 0. 05). The amount of bleeding was significantly lower in the observation group than in the control group( P < 0. 05),and the degree of cerebral edema was significantly milder than in the control group( all P <0. 05). Conclusion The use of aprotinin drugs in patients undergoing surgery for brain tumor can protect platelet function,prolong clotting time,reduce the release of inflammatory mediators,and have a good effect on patients' coagulation function and inflammatory inhibition,which is worthy of clinical promotion.
Objective To investigate the effect of aprotinin on blood coagulation function and serum inflammatory mediator level in patients undergoing surgery for brain tumor. Methods A total of 58 patients who underwent surgery for brain tumors at Shanghai Pudong Hospital from March 2016 to March 2018 were selected as subjects. The random number table method was used and the patients were divided into an observation group and a control group with 29 patients in each group. In the observation group,Ringer's solution with aprotinin was intravenously injected from 12 h before the surgery to 24 h after the operation,and the control group was injected with the same volume of Ringer's solution. The differences in coagulation parameters and serum inflammatory mediator levels between the two groups before induction( T1),intraoperation( T2),and 24 h postoperation( T3) were observed. Results The prothrombin time( PT),activated partial thromboplastin time( APTT),fibrinogen( FIB),coagulation rate( CR),activated coagulation time( ACT) and platelet function( PF) in the observation group were significantly higher or lower in T2 phase than in T1 phase( all P < 0. 05). The PT,FIB,CR,ACT and PF in the control group were significantly higher or lower in T2 phase than in T1 phase.( all P < 0. 05). In T2 phase,the levels of APTT and PF in the observation group were significantly higher than in the control group( all P < 0. 05). There was no significant difference in the levels of IL-6 and TNF-α between the two groups in T1 phase( P > 0. 05). The levels of IL-6 and TNF-α in the two groups were significantly higher than in the T1 phase( all P < 0. 05). The levels of IL-6 and TNF-α in the T2 and T3 phases in the observation group were significantly higher than in the control group( all P < 0. 05). The amount of bleeding was significantly lower in the observation group than in the control group( P < 0. 05),and the degree of cerebral edema was significantly milder than in the control group( all P <0. 05). Conclusion The use of aprotinin drugs in patients undergoing surgery for brain tumor can protect platelet function,prolong clotting time,reduce the release of inflammatory mediators,and have a good effect on patients' coagulation function and inflammatory inhibition,which is worthy of clinical promotion.
引文
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[12]廖国平,邓芳文,孙德贵,等.抑肽酶与赖氨酸类药物在心脏手术中疗效比较的Meta分析[J].临床医药实践,2016,25:723-730.
[13]何灏澜.肝硬化腹水浓缩回输术后腹腔内注射抑肽酶减少腹腔内粘连临床观察[J].中外医疗,2014,33:47-48.
[14]邵秀锦,余志良,裘娟萍.微生物源胰蛋白酶抑制剂的研究进展[J].科技通报,2016,32:56-62.
[15]母传利.探讨围术期应用抑肽酶减少脑肿瘤手术出血及脑水肿的临床效果[J].临床医学,2015,15:111-112.
[16]刘雨春.抑肽酶对脑外科手术患者的血液保护作用探讨[J].北方药学,2017,14:50.
[17]查昀,顾文菊.抑肽酶和氨甲环酸对脑肿瘤切除术患者的疗效分析[J].中国医药指南,2017,15:65-66.
[2]Pereira S,Pinto A,Alves V,et al.Brain tumor segmentation using convolutional neural networks in MRI images[J].IEEETrans Med Imaging,2016,35:1240-1251.
[3]林佳才,伍思婷,石强.脑膜癌病患者的临床表现及影像学特点研究[J].解放军医学杂志,2016,41:216-220.
[4]李琰琰,赵腾,马恒敏,等.2002~2013年山东省肥城市恶性肿瘤的发病与死亡分析[J].中国肿瘤,2018,27:261-266.
[5]刘胜美,黄权,阮珍义,等.立体定向微创手术联合吡拉西坦治疗脑肿瘤的临床疗效[J].中国肿瘤临床与康复,2016,23:1079-1081.
[6]李树栋,孟兴凯.抑肽酶在肝脏外科中的应用进展[J].医学综述,2015,21:4080-4082.
[7]常久魁,刘晓荣,郑建辉,等.抑肽酶对脑肿瘤手术患者血清炎症因子水平的影响[J].实用癌症杂志,2016,31:1436-1437.
[8]李小帅,于绍楠,邢洁,等.原发性脑内淋巴瘤的MRI表现及病理对照[J].中国实验诊断学,2017,21:1311-1314.
[9]Hottinger AF,Patricia P,Roger S.Tumor treating fields:a novel treatment modality and its use in brain tumors[J].Neuro-Oncol,2016,18:1338-1349.
[10]Ostrom QT,Gittleman H,de Blank PM,et al.American brain tumor association adolescent and young adult primary brain and central nervous system tumors diagnosed in the United States in2008-2012[J].Neuro-Oncol,2016,1 uppl 1:i1-i50.
[11]胡芳,周霞,杨波.立体定位放射疗法联合脑血管介入栓塞术治疗高血运性脑恶性肿瘤的临床效果及其对患者预后的影响研究[J].实用心脑肺血管病杂志,2016,24:198-201.
[12]廖国平,邓芳文,孙德贵,等.抑肽酶与赖氨酸类药物在心脏手术中疗效比较的Meta分析[J].临床医药实践,2016,25:723-730.
[13]何灏澜.肝硬化腹水浓缩回输术后腹腔内注射抑肽酶减少腹腔内粘连临床观察[J].中外医疗,2014,33:47-48.
[14]邵秀锦,余志良,裘娟萍.微生物源胰蛋白酶抑制剂的研究进展[J].科技通报,2016,32:56-62.
[15]母传利.探讨围术期应用抑肽酶减少脑肿瘤手术出血及脑水肿的临床效果[J].临床医学,2015,15:111-112.
[16]刘雨春.抑肽酶对脑外科手术患者的血液保护作用探讨[J].北方药学,2017,14:50.
[17]查昀,顾文菊.抑肽酶和氨甲环酸对脑肿瘤切除术患者的疗效分析[J].中国医药指南,2017,15:65-66.