低分子肝素与低分子右旋糖酐预防全髋关节置换术后深静脉血栓的研究

Effect and safety of low molecular weight heparin and low molecular weight dextran injection for prevention of deep vein thrombosis after total hip apthroplasty

目的探讨低分子肝素联合低分子右旋糖酐注射液预防人工全髋关节置换术后深静脉血栓的临床效果和安全性。方法回顾性分析2007年4月至2009年4月32例THA术后预防性应用LMWH和LMWD患者发生DVT和术后出血的情况,其中抗凝组术前12h均应用LMWH2500U,术后6h后应用LMWH剂量为5 000 U/d者14例(高剂量组)、2 500 U/d者18例(低剂量组),时间7～14d,均联合手术当日应用LMWD500ml至1000ml;并与2003年4月至2005年4月35例THA术后未应用LMWH和LMWD患者35例(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9例(25.7%)、高剂量组1例(7.1%)、低剂量组2例(11.1%)发生DVT,其中对照组有1例DVT继发PTE死亡,抗凝组无死亡。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)。高剂量组、低剂量组及对照组术后出血量和输血量分别为(401.5±90.7)和(619.2±264.8)、(363.5±96.6)和(486.7±269.7)、(319.7±89.2)和(430±192.5)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)。抗凝组未发生溃疡出血、心功能不全等严重出血并发症。结论低分子肝素联合低分子右旋糖酐注射液预防人工全髋关节置换术后深静脉血栓是一种安全有效的方法。

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）with Low molecular weight dextran injection（LMWD）.Methods The occurrence condition of DVT and postoperative bleeding in 32 cases undergoing THA treated with LMWH and LMWD between apirl 2007 and apirl 2009 was restrospectively analyzed.Among them are applied 12h anticoagulant group preoperative and postoperative LMWH2500U 6h after application for 5 000 LMWH dose the U/d 14 cases（high dose group）,2 500 U/d the 18 cases（low dose group）,7~14 days,time are combined surgery LMWD500ml to 1000ml on application.Another 35 cases undergoing THA without LMWH or LMWD treating between apirl 2003 and apirl 2005 were used as control group.There was no significant difference in gender,age,illness cause,course of disease,or the type of prosthesis among three groups（P0.05）.Results DVT occurred in 9 cases（25.7%）of control group,in1 case（7.1%）of high dose group,and in2cases（11.1%）of low dose group,1 case died of PTE after DVT among control group,no case died in treatment groups,showing significant differences between two treatment groups and control group（P0.05）,but nosignificant difference between two treatment groups（P0.05）.The postoperative blood loss and blood transfusion in high dose group,low dose group,and control group was（401.5±90.7）and（619.2±264.8）,（363.5±96.6）and（486.7±269.7）,（319.7±89.2）and（430±192.5）ml;There was no significant difference between the high and low dose groups,between low dose and control groups（P0.05）,while showing significant difference between high dose and control groups（P0.05）.In two treated groups no ulcer bleeding,heart failure,severe bleeding complications.Conclusions LMWH and LMWD can reduce the DVT incidence rate in THA and has good safety.