应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究

The efficacy of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism in elderly patients before hip fracture surgery

目的评估低分子肝素（low-molecular-weight heparin,LMWH）钙预防剂量与治疗剂量预防老年髋部骨折患者静脉血栓栓塞症（venous thromboembolism,VTE）的安全性.方法前瞻性收集2013 年9 月至2015 年7 月华北理工大学附属骨科医院创伤骨科收治的符合纳入及排除标准的老年髋部骨折患者125 例,随机分为试验组（n=56）和对照组（n=69）.试验组术前按照LMWH 钙常规治疗血栓剂量预防VTE,对照组应用常规预防血栓剂量,比较两组患者VTE 的发生率及凝血功能的变化.结果通过下肢彩超及静脉造影检查,试验组患者深静脉血栓的发生率为10.7%（6/56）,对照组为26.1%（18/69）,差异有统计学意义（χ2=4.709,P 〈 0.05）.试验组无肺动脉栓塞发生,对照组肺动脉栓塞发生率为2.9%,差异无统计学意义（P 〉 0.05）.两组患者骨折后2 d 和术前1 d的活化部分凝血活酶时间（activated partial thromboplastin time,APTT）、血纤蛋白原（fibrinogen,FBG）和血小板计数（platelet court,PLT）比较,差异均无统计学意义（P 〉 0.05）.结论老年髋部骨折患者术前采用LMWH 钙治疗剂量预防VTE 的效果优于预防剂量.

ObjectiveTo evaluate the efficacy and reliability of low molecular weight heparincalcium of preventive versus therapeutic dose in prevention of venous thromboembolism （VTE） in elderlypatients before hip fracture surgery. MethodsBetween September 2013 and July 2015, 125 patients wererecruited according to the diagnostic criteria and colleted prospectively. They were divided into experimentalgroup （n=56） and control group （n=69） randomly. Low molecular weight heparin calcium of therapeuticdose was administered for the experimental group versus preventive dose for the control group in preventionof VTE in elderly patients before hip fracture surgery. Comparisons were made between the two groups inrespects of the incidence of VTE, APTT, FBG, and PLT. ResultsDVT was detected by means of B-modeultrasonography and venography. The rate of DVT in the experimental group was 10.7% （6/56）, and 26.1%（18/69） in control group. The differences between the two groups were statistically significant （χ2=4.709,P〈0.05）. The PE rate was 2.9% in control group, but the rate of PE in experimental group was zero. Thedifference of PE rate was not statistically significant between the two groups （P〉0.05）. The differences ofAPTT, FBG, and PLT between the two groups were not statistically significant （P〉0.05）. ConclusionTheefficacy of low molecular weight heparin calcium of therapeutic dose is better than that of preventive dosein prevention of VTE.