Eriksson B I, Hultman E, Martinell S, Eriksson E, Tengborn L, Risberg B
Institution of Orthopedics, University of Göteborg, Sweden.
Thromb Res. 1991 Jun 1;62(5):441-7. doi: 10.1016/0049-3848(91)90017-q.
The local effect of operative trauma on the fibrinolytic system was studied in ten patients undergoing total hip replacement. Catheters were inserted in the femoral veins on both sides and blood was sampled from these catheters perioperatively. The following fibrinolytic variables were analysed in plasma and related to the different steps of surgery: tissue plasminogen activator (t-PA) activity, t-PA antigen and plasminogen activator inhibitor (PAI-1) activity. During surgery PAI-1 activity and t-PA antigen in the operated limb were significantly increased compared with preoperative values. There was a significant difference in PAI-1 activity and t-PA antigen between the operated and the non-operated limbs during surgery and within one hour postoperatively. During fixation of the femoral implant there was a significant difference between the operated and the non-operated limbs in t-PA activity. Thus the regional fibrinolytic response to trauma was dissociated from the response in the non-operated limb. The clinical relevance of the observed alterations in regional fibrinolysis, as related to thrombogenic mechanisms after hip surgery, remains to be elucidated.
在10例行全髋关节置换术的患者中研究了手术创伤对纤溶系统的局部影响。在双侧股静脉插入导管，并在围手术期从这些导管采集血液样本。分析血浆中的以下纤溶变量，并将其与手术的不同步骤相关联：组织纤溶酶原激活物（t-PA）活性、t-PA抗原和纤溶酶原激活物抑制剂（PAI-1）活性。手术期间，手术侧肢体的PAI-1活性和t-PA抗原与术前值相比显著增加。手术期间及术后1小时内，手术侧与非手术侧肢体的PAI-1活性和t-PA抗原存在显著差异。在股骨植入物固定期间，手术侧与非手术侧肢体的t-PA活性存在显著差异。因此，创伤区域的纤溶反应与非手术侧肢体的反应不同。与髋关节手术后血栓形成机制相关的区域纤溶变化的临床相关性仍有待阐明。
