血栓弹力图和D-二聚体在髋关节置换术患者围术期的变化

Perioperative changes of parameters of thromboelastography and D-Dimer in patients undergoing hip replacement

【目的】研究血栓弹力图和D-二聚体在髋关节置换术患者围术期的变化。【方法】观察组为20例股骨颈骨折行髋关节置换术的老年患者，分别于麻醉前（T0）、手术开始后2h（T1）、术后第1天（T2）和术后第3天（L）采静脉血，检测血栓弹力图（TEG）指标（参数为R值、k值、α角、MA、CI）和D-二聚体浓度。另选10例健康人做为对照组。【结果】对照组各项指标均正常。观察组TEG的R值缩短，α角、MA、CI增大，与对照组比较均差异有显著性（P〈0．05），观察组内K值在T2与T0比较差异有显著性（P〈0．05），α在T2与T0比较，MA在T3与T0比较，CI在T2、T3分别与T0比较均差异有显著性（P〈0．05）。观察组D-二聚体明显高于对照组（P〈0．05）。【结论】股骨颈骨折行髋关节置换术患者术前、术中及术后血液呈不同程度高凝状态，术后1～3d有加重趋势，TEG和D-二聚体是判断血液高凝状态的敏感性指标，TEG各项指标中与高凝状态关系密切的是R值、α角、MA、CI。

[ Objective] To explore the perioperative changes of parameters of thromboelastography and D-Dimer in patients undergoing hip replacement. [Methods] Thromboelastography variables （R, K,α angle, MA and CI） and D-Dimer level were measured in 20 aged patients undergoing hip replacement before anesthesia （To）, 2 h after operation begining （%）, 1 d and 3 d after operation （T2, T3 ） .The control group consists of ten healthy adults. [ Results] All parameters in control group were normal. In hip replacement group, R was shorter, α angle, MA and CI were larger than control group （ P 〈 0.05） .K at T2 was shorter than that at To （ P 〈 0.05）, a angle and CI at T2 were larger than that at To （ P 〈 0.05）, MA and CI at T3 were larger than that at To （P〈0.05） . D- Dimer/eve/ increased significantly in test group than control group （P〈0.05） [Conclusions] The perioperative patients of hip replacement are in blood hypereoagulable state, and become worse step and step after eration. D - Dimer and TEG are sensitive indexes to evaluate the blood hypereoagulable state. Of TEG indexes, R, α angle, MA and CI are relative strongly to hypercoagtdability.