老年患者骨水泥型人工髋关节置换前后的凝血功能

Changes of blood clotting in elderly patients prior to and after cemented hip replacement

背景:由于老年患者自身的高凝倾向,骨水泥型人工髋关节置换后更容易发生深静脉栓塞、弥漫性血管内凝血、肺栓塞、脑栓塞等并发症。目的:观察老年患者骨水泥型人工髋关节置换前后凝血4项凝血酶原时间、活化部分凝血活酶时间、凝血酶时间和纤维蛋白原的变化。方法:检测40例人工髋关节置换老年患者骨水泥植入前10min,植入后30min、1h、2h、3h凝血酶原时间、活化部分凝血活酶时间、凝血酶时间和纤维蛋白原各项指标。结果与结论:与植入前10min比较,植入后30min凝血酶原时间明显下降(P<0.05),纤维蛋白原明显升高(P<0.05),植入后3h均恢复到植入前状态(P>0.05)。活化部分凝血活酶时间、凝血酶时间在骨水泥植入前后变化均不明显(P>0.05)。结果表明患者在骨水泥植入后短时间内会出现高凝血状态,在植入3h后基本消除,提示在植入骨水泥后的3h是监测凝血的重要时间段。

BACKGROUND： As the high blood clotting of the elderly patients, the complications may occur more easily after cemented hip replacement, such as deep venous embolism, disseminated intravascular coagulation, pulmonary embolism and cerebral embolism. OBJECTIVE： To explore the changes of four blood clots index, such as the prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT） and fibrinogen （FIB） after cemented hip replacement in elderly patients. METHODS： The PT, APTT, TT and FIB of 40 elderly patients with artificial hip replacement was detected at 10 minutes before implantation and 30 minutes, 1, 2, 3 hours after implantation, respectively. RESULTS AND CONCLUSION： Compared with 10 minutes before implantation, the PT of 30 minutes after implantation was significantly decreased （P 0.05）, and the FIB was increased obviously （P 0.05）, and restored to the normal state at 3 hours after implantation （P 0.05）. The changes of APTT and TT before and after implantation were not significant （P 0.05）. The results showed that there were high blood clots in a short time after bone cement implantation, and disappeared at 3 hours after implantation. Three hours after bone cement implantation was the best time to detect the blood clots.