The Effects Of Ulinastatin On Blood Coagulation In Patients With Laparoscopic Resection Of Pancreas Duodenum

Objective: The perioperative blood coagulation system changing of patients under went laparoscopic resection of pancreatic duodenal were monitored by PT, APTT and TEG. By comparing the experimental groups and control groups to analysis the ulinastatin’s influence on coagulation and research ulinastatin’s mechanism and acting way on the changes of coagulation function, we can provide clinical advices about maintaining perioperative coagulation function for patients who had laparoscopic resection of pancreatic duodenal.Methods: The patients who were under the surgery with laparoscopic resection of pancreatic duodenal were chosen from the Second Hospital of Hebei Medical University Liver and Gallbladder Surgery Apartment during the period from 2014/4 to 2014/12. The cases include 40 patients aged from 35 to 70 whose blood loss or transfusion amount was less than 1000 ml and they were in the same surgery group with normal coagulation function. The chosen patients were randomly divided into experimental group(U group) and control group(C group), each group was divided into group 1(intraoperative bleeding less than 500 ml, no blood transfusion and plasma) and group 2(intraoperative bleeding less than 1000 ml, great than 500 ml, blood transfusion and plasma volume less than 1000ml). Experimental groups were given ulinastatin 10000U/kg after anesthesia induction and 5000 U/kg ulinastatin dissolved into 100 ml normal saline the first day, second day and third day after surgery while control groups were given 100 ml saline at the same time. Drawing the venous blood at time of entering operation room(T0), surgery ending(T1), 24 h after surgery(T2), 48 h after surgery(T3), 72 h after surgery(T4) respectively to detect thrombus elastic figures, red blood cell counts, platelet counts, PT and APTT. All test data were analyzed by SPSS13.0 statistical software and count data of normal distribution were described by using the mean±standard deviation. Use the way of measuring variance analysis repeatedly to compare the differences between each group, analysis the measurement data by X2, consider the difference that P was less than 0.05 has statistically significance.Results: 1 The four group patients’ sex ratio, age, weight and operation time had no significant difference. Four group patients’ hemoglobin count, platelet count, ACT, R, K, Angle, MA, PT and APTT values were within the normal range before surgery and the differences among them had no statistical significance(P>0.05).2 ACT values were different among the four treatment groups(P<0.05). The difference between experiment group 1 and control group 2, experiment group 2 and control group 1, experiment group 2 and control group 2 had statistical significance(P<0.05). There was no statistically significant difference for the other two groups(P>0.05). The trends of ACT values in different time phase were different, the experiment groups were stable.3 Angle values were different among the four treatment groups(P<0.05). The difference between experiment group 1 and control group 1, experiment group 1 and control group 2, experiment group 2 and control group 2 had the statistically significance(P<0.05). The trends of Angle values were different under different treatment factors, the Angle of control groups had a more large decrease.4 MA values were different among the four treatment groups(P<0.05). The difference between experiment group1 and control group 2, experiment group 2 and control group 2 had statistically significance(P<0.05) while the other two groups had no statistically significance(P>0.05). The trends of MA values were different under different process factors, the MA values of control groups had a more obvious decrease.5 The PT and APTT values had no differences among four groups(P> 0.05). Compared with T0 phase, the PT values increase at T3, PT and APTT values increased at T4 and the differences had statistical significance(P<0.05).6 MA values and platelet counts have a linear correlation trend. The correlation coefficient of each phase was r0 = 0.551, r1= 0.434, r2 = 0.423, r3 = 0.441, r4 = 0.362. The APPT values and platelet counts had no linear correlation.Conclusion: Ulinastatin has improved patients’ perioperative blood coagulation function under the laparoscopic pancreatic duodenal resection. Thrombelastograph response the changes of the blood coagulation system more detailed and timely, the value of MA with the number of platelets has good correlation.