自拟抗栓方联合低分子肝素钠预防髋、膝部手术后深静脉血栓形成的临床研究

Clinical study on the self-designed antithrombotic prescription combined with low molecular weight heparin sodium in the prevention of deep vein thrombosis after operations in the hip and the knee

目的:探讨自拟抗栓方预防髋、膝部手术后下肢深静脉血栓形成的临床疗效。方法:将符合要求的133例患者随机分为2组,Ⅰ组65例,Ⅱ组68例。术后当天即开始预防血栓治疗,Ⅰ组采用自拟抗栓方和低分子肝素钠治疗;Ⅱ组单纯使用低分子肝素钠治疗。同时,2组均常规给予抗生素预防感染,并进行功能锻炼和康复治疗。术后第8天统计2组患者下肢深静脉血栓发生情况,并分别于术前、术后2 d、术后7 d测定2组患者的全血黏度、血浆黏度、红细胞压积、红细胞聚集指数及纤维蛋白原等血液流变学指标。结果:①Ⅰ组患者2例发生深静脉血栓,Ⅱ组10例发生深静脉血栓。2组患者深静脉血栓发生情况比较,差异有统计学意义(2χ=4.262,P=0.039)。②全血低切黏度:两组治疗前后不同时间全血低切黏度比较,存在时间效应(F=135.374,P=0.000)和分组效应(F=17.096,P=0.042);时间与组别之间存在交互效应(F=120.980,P=0.000);不同时点组间比较,差异均无统计学意义(t=0.057,P=0.957;t=-0.114,P=0.915;t=-0.900,P=0.419)。③全血高切黏度:两组治疗前后不同时间全血高切黏度比较,存在时间效应(F=80.971,P=0.000)和分组效应(F=39.118,P=0.003);时间与组别之间不存在交互效应(F=2.102,P=0.185);不同时点组间比较,差异均无统计学意义(t=-0.162,P=0.879;t=0.012,P=0.991;t=-0.530,P=0.624)。④血浆黏度:两组治疗前后不同时间血浆黏度比较,存在时间效应(F=18.814,P=0.001)和分组效应(F=9.265,P=0.034);时间与组别之间存在交互效应(F=17.156,P=0.001);不同时点组间比较,差异均无统计学意义(t=-0.087,P=0.935;t=-0.157,P=0.883;t=-1.469,P=0.216)。⑤红细胞压积:两组治疗前后不同时间红细胞压积比较,存在时间效应(F=18.988,P=0.012),但不存在分组效应(F=0.101,P=0.767);时间与组别之间存在交互效应(F=7.328,P=0.016);不同时点组间比较,差异均无统计学意义(t=0.016,P=0.988;t=-0.106,P=0.921;t=-0.985,P=0.380)。⑥红细胞聚集指数:两组治疗前后不同时间红细胞聚集指数比较,存在时间效应(F=24.763,P=0.000),但不存在分组效应(F=0.424,P=0.550);时间与组别之间存在交互效应(F=35.746,P=0.000);不同时点组间比较,差异均无统计学意义(t=-1.161,P=0.880;t=-1.106,P=0.921;t=-1.966,P=0.121)。⑦纤维蛋白原:两组治疗前后不同时间纤维蛋白原比较,存在时间效应(F=12.496,P=0.003),但不存在分组效应(F=0.015,P=0.909);时间与组别之间存在交互效应(F=7.874,P=0.013);不同时点组间比较,差异均无统计学意义(t=-0.032,P=0.976;t=-0.178,P=0.867;t=-0.555,P=0.609)。结论:自拟抗栓方联合低分子肝素钠能有效预防髋、膝部手术后深静脉血栓形成,可在临床推广应用。

Objective：To explore the clinical curative effects of the self-designed antithrombotic prescription in the prevention of deep vein thrombosis（DVT）after operations in the hip and the knee.Methods：One hundred and thirty-three patients met the criteria were randomly divided into 2 groups.Sixty-five cases in groupⅠ,while the others in groupⅡ.Treatment of preventing thrombus was carried out on that day after the operation.Patients in groupⅠwere administrated with self-designed antithrombotic prescription combined with low molecular weight heparin sodium,while the others in groupⅡwere administrated with low molecular weight heparin sodium only.Meanwhile,patients in the 2 groups were routinely given antibiotics to prevent infection and were administrated with functional exercise and rehabilitation therapy.Occurrences of DVT for patients in the 2 groups were recorded in the 8th day after operation,and their blood viscosity,plasma viscosity,hematocrit,erythrocyte aggregation indexes,fibrinogen and other blood rheology indexes were measured before the operation,in the 2nd and the 7th day after operation respectively.Results：①Two DVT cases were found in groupⅠ,and 10 DVT cases were found in groupⅡ.There was statistical difference in the incidence of DVT between the 2 groups（χ2=4.262,P=0.039）.②On the aspect of low shear blood viscosity：there were time effect（F=135.374,P=0.000）,group effect（F=17.096,P=0.042）and interaction between times and groups（F=120.980,P=0.000）;there was no statistical difference between the 2 groups in different time points（t=0.057,P=0.957;t=-0.114,P=0.915;t=-0.900,P=0.419）.③On the aspect of high shear blood viscosity：there were time effect（F=80.971,P=0.000）and group effect（F=39.118,P=0.003）,but there was no interaction between times and groups（F=2.102,P=0.185）;there was no statistical difference between the 2 groups in different time points（t=-0.162,P=0.879;t=0.012,P=0.991;t=-0.530,P=0.624）.④On the aspect of plasma viscosity：there were time effect（F=18.814,P=0.001）,group effect（F=9.265,P=0.034）and interaction between times and groups（F=17.156,P=0.001）;there was no statistical difference between the 2 groups in different time points（t=-0.087,P=0.935;t=-0.157,P=0.883;t=-1.469,P=0.216）.⑤On the aspect of hematocrit：there were time effect（F=18.988,P=0.012）and interaction between times and groups（F=7.328,P=0.016）,but there was no group effect（F=0.101,P=0.767）;there was no statistical difference between the 2 groups in different time points（t=0.016,P=0.988;t=-0.106,P=0.921;t=-0.985,P=0.380）.⑥On the aspect of erythrocyte aggregation indexes：there were time effect（F=24.763,P=0.000）and interaction between times and groups（F=35.746,P=0.000）,but there was no group effect（F=0.424,P=0.550）;there was no statistical difference between the 2 groups in different time points（t=-1.161,P=0.880;t=-1.106,P=0.921;t=-1.966,P=0.121）.⑦On the aspect of fibrinogen：there were time effect（F=12.496,P=0.003）and interaction between times and groups（F=7.874,P=0.013）,but there was no group effect（F=0.015,P=0.909）;there was no statistical difference between the 2 groups in different time points（t=-0.032,P=0.976;t=-0.178,P=0.867;t=-0.555,P=0.609）.Conclusion：Self-designed antithrombotic prescription combined with low molecular weight heparin sodium is effective in the prevention of deep vein thrombosis after operations in the hip and the knee,and it is worth popularizing in the clinic.