关节置换手术低分子肝素预防深静脉栓塞使用时机的初步研究

The preliminary study of low molecular weight heparin using timing to prevent deep vein thrombosis in joint replacement surgery

目的探讨低分子肝素预防深静脉栓塞(deep vein thrombosis,DVT)的使用时机。方法单侧初次关节置换164例,其中全髋关节置换术(totalhip replacement,THR)103例,术前开始使用低分子肝素32例,术中开始使用28例,术后43例;全膝关节置换术(totalknee replacement,TKR)61例,术前开始使用低分子肝素23例,术中开始使用16例,术后开始使用22例。比较DVT的发生率,并引入隐性失血量,计算总失血量,评价安全性。结果①THR患者术前开始使用低分子肝素组总失血量平均为1626ml,术中开始使用组平均为1857ml,术后开始使用组平均为1366ml;TKR患者术前开始使用组失血量平均为1530ml,术中开始使用组平均为1780ml,术后开始使用组平均为1258ml。比较THR和TKR术前开始使用与术中、术后开始使用低分子肝素三者的总失血量均有统计学意义。②术前使用组DVT的发生率为20.0%,术中使用组DVT发生率为18.2%,术后使用组DVT发生率为24.6%,差异无统计学意义。结论术前和术中使用低分子肝素预防DVT有效,但出血量明显增多;术后使用低分子肝素失血量少,且DVT的发生率和术前、术后使用低分子肝素效果相当。

Objective To explore low molecular weight heparin using timing in joint replacement surgery. Methods 164 patients underwent primary unilateral total arthroplasty including 103 patients underwent THR using LMWH for 32 patients preoperatively, using LMWH for 28 patients pcroperatively and 43 patients postoperatively;61 patients underwent TKR,using LMWH for 23patients preoperatively,using LMWH for 16 patients peroperatively and 22 patients postoperatively. The DVT incidence rates were compared among LMWH using timing. Computing the total blood loss through the introduction of hidden hemorhage, We evaluate the efficacy and safeness. Results ① In THR preoperatively LMWH using group,the blood loss was 1626ml;in peroperatively using group,the blood loss was 1857ml;and in postoperatively using group, the blood loss was 1366 ml. In TKR preoperatively LMWH using group,the blood loss was 1530ml;in peroperatively using group, the blood loss was 1780ml;and in postoperatively using group, the blood loss was1258ml. So there were significant differences among the three groups in the amount of total blood loss of patients. ②The incidence rate of DVT was 20.0% in the preoperative group, Conclusion Preoperatively or peroperatively using LMWH can obviously increase the total blood loss, postoperatively using LMWH increase less, morever the DVT incidences of three groups were not differential, it was 18.2% in the peroperative group and it was 24.6% in the postoperative group. There were no difference in the DVT incidence.