低分子肝素预防人工全髋关节置换术后深静脉血栓疗效观察

EFFECTIVENESS OF LOW MOLECULAR WEIGHT HEPARIN FOR PREVENTION OF DEEP VEIN THROMBOSIS AFTER TOTAL HIP ARTHROPLASTY

目的探讨人工全髋关节置换(total hip arthroplasty,THA)术后深静脉血栓(deep vein thrombosis,DVT)发病规律,以及低分子肝素(low molecular weight heparin,LMWH)的预防效果。方法回顾性分析2003年2月-2004年3月90例THA术后预防性应用LMWH患者发生DVT的情况,其中应用LMWH剂量为5000U/d者39例(高剂量组)、2500U/d者51例(低剂量组);并与2002年2月-2003年2月90例THA术后未应用LMWH患者(对照组)进行比较。各组患者性别、年龄、病因、病程、假体类型等比较,差异均无统计学意义(P>0.05),具有可比性。结果术后1个月内对照组19例(21.1%)、高剂量组2例(5.1%)、低剂量组5例(9.8%)发生DVT,对照组与后两组比较差异均有统计学意义(P<0.05);高、低剂量组间比较差异无统计学意义(P>0.05)。各组内男女患者、年龄>65岁及≤65岁者、创伤及骨病患者DVT发生率比较,以及以上因素组间同一类型患者比较,差异均无统计学意义(P>0.05)。各组骨水泥型患者DVT发生率均高于非骨水泥型患者(P<0.05);组间同一类型患者比较,差异均无统计学意义(P>0.05)。高剂量组、低剂量组及对照组术后出血量分别为(463.5±234.2)、(342.4±231.6)(288.2±141.6)mL;高、低剂量组之间、低剂量组与对照组比较,差异均无统计学意义(P>0.05);而高剂量组与对照组间差异有统计学意义(P<0.05)。结论骨水泥型THA术后患者DVT发生率提高;LMWH可显著降低其发生率,且具有良好的安全性。

Objective To investigate the pathogenesis of deep vein thrombosis （DVT） after total hip arthroplasty （THA） and the preventive effectiveness of low molecular weight heparin （LMWH）. Methods The occurrence condition of DVT in 90 cases undergoing THA treated with LMWH between February 2003 and March 2004 was restrospectively analyzed. Among 90 cases, 39 were treated with LMWH at a dose of 5 000 U/day （high dose group） and 51 at a dose of 2 500 U/day （low dose group）. Another 90 cases undergoing THA without LMWH treating between February 2002 and February 2003 were used as control group. There was no significant difference in gender, age, illness cause, course of disease, or the type of prosthesis among 3 groups （P〈0.05）. Results DVT occurred in 19 cases （21.1%） of control group, in 2 cases （5.1%） of high dose group, and in 5cases （9.8%） of low dose group, showing significant differences between two treated groups and control group （P〈0.05）, but no significant difference between two treated groups （P〈0.05）. There was no significant difference in gender, age （ 65 years and ≤ 65 years）, pathogen （trauma and bone disease） of each group, as well as of the same type patients within 3 groups （P〈0.05）. The DVT incidence rate in the patients with bone cement artificial joint was significantly higher than that in the patients with non-bone cement artificial joint （P〈0.05）, but there was no significant difference in the same type patients within 3 groups （P 〈0.05）. The postoperative blood loss in high dose group, low dose group, and control group was （463.5 ± 234.2）, （342.4 ± 231.6）, and （288.2 ± 141.6） mL; showing no significant difference between the high and low dose groups, between low dose and control groups （P〈0.05）, while showing significant difference between high dose and control groups （P〈0.05）. Conclusion The DVT incidence rate in THA patients with bone cement artificial joint is high; LMWH can reduce the DVT incidence rate and has good safety.