髋部骨折对老年患者凝血功能的影响

Impact of hip fracture on coagulation function in elderly patients

目的:通过检测纤维蛋白原(fibrinogen,FIB)、D-二聚体等凝血指标的变化,观察髋部骨折对老年患者凝血功能的影响。方法:选择2011年1月至2012年3月在北京大学人民医院以髋部骨折入院的老年患者127例,采集患者术前、术后静脉血,检测FIB和D-二聚体,并统计年龄、骨折类型、骨折时间、合并疾病等因素。结果:127例老年髋部骨折患者术前FIB为(3.91±1.06)g/L,其中42.52%(54/127)的患者高于正常值;所有患者中28例术后进行了FIB检测,均值为(4.21±1.24)g/L,高于手术前,但两者差异无统计学意义;术前15例患者进行D-二聚体测定,均值为(2 059.5±1 948.0)μg/L,术后26例患者进行D-二聚体测定,均值为(2 574.9±1 702.4)μg/L,术前、术后D-二聚体均显著高于正常值(P<0.05);FIB升高与年龄、是否合并糖尿病、心脑血管疾病无关;术前股骨粗隆间骨折患者FIB升高的比例为45.83%(22/48),股骨颈骨折患者FIB升高的比例为40.50%(32/79),两者相比差异无统计学意义;按照骨折时间分组,骨折时间大于96 h组,其FIB高于正常值的比例为26.7%,显著低于其他组,差异有统计学意义(P<0.05)。结论:髋部骨折对老年患者的凝血系统具有直接影响,FIB和D-二聚体显著高于正常值。根据髋部骨折后FIB的变化情况,推测骨折后96 h行手术可能对患者凝血系统打击最小。

Objective： To investigate the impact of hip fracture on coagulation function in elderly pa- tients. Methods： In our study, 127 elderly patients with hip fracture were diagnosed and admitted to Pe- king University People＇ s Hospital from January 2011 to March 2012. Specimens of their venous blood were obtained before and after the surgery, and measured for fibrinogen （FIB） and D-dimer. Also, we analyzed their age, type of fracture, fracture time, and concomitant diseases. Results： The FIB level of the patients （127 cases） before surgery was （3.91 ± 1.06） g/L, and 42.52% （54/127） patients＇ FIB was higher than normal. After the surgery, 28 patients underwent FIB test [ （4.21 ± 1.24） g/L], which was higher than the FIB value before surgery, but was not statistically significant. Before surgery, 15 pa- tients underwent D-dimer test [ （2 059.5 ± 1 948.0） μg/L]. After the surgery, 26 patients underwent D-dimer test [ （2 574.9 ± 1 702.4） μg/L]. The two values were significantly higher than normal （P 〈 0.05 ）. The elevated value of FIB had no relationship withage, diabetes, cardiovascular or cerebrovascu- lar diseases. Before surgery, 45.83% （22/48） of theintertrochanteric fracture patients had abnormal FIB, and 40.50% （32/79） of the patients with femoral neck fracture had abnormal FIB, but they were not statistically significant. Grouped according to the fracture time, when fracture time was longer than 96 h, the ratio of abnormal FIB was 26.7%, lower than those of other groups, and the difference was statis- tically significant （ P 〈 0.05 ）. Conclusion： The hip fracture in elderly patients has a direct impact on co- agulation system, and FIB and D-dimer have significantly changed. According to the variation of FIB af- ter fracture,we speculate that fracture surgery after 96 h may affect the coagulation system at the lowest level.