骨折后及二次骨折后患者血液流变学变化的临床研究

Clinical study of hemorrheology changes after fracture or secondary fracture

目的比较骨折病史病人再次骨折与无骨折病史病人血流变学的变化,从而探讨骨折病史对于二次骨折后血栓形成的影响,为预防血栓的形成提供参考依据。方法对30例有骨折史的二次骨折患者、100例首次骨折患者、80例健康体检者的血流变指标、凝血指标、血流动力学指标、血清D-二聚体含量以及下肢血管彩超结果进行比较。结果 (1)除红细胞压积外,其余血液流变学各指标和凝血四项指标3组间的差异均有统计学意义(P<0.05);比较血流动力学各个指标,差异无统计学意义(P>0.05)。骨折患者血液流变学各指标均显著高于健康体检者(P<0.05),二次骨折患者显著高于首次骨折患者(P<0.05);凝血四项显示,骨折患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)短于健康体检者,二次骨折患者短于首次骨折患者,骨折患者的纤维蛋白原(FIB)浓度高于健康体检者,二次骨折患者高于首次骨折患者,差异均有统计学意义(P<0.05)。(2)二次骨折患者和首次骨折患者的血清D-二聚体含量和下肢深静脉血栓发生率显著高于健康体检者,二次骨折患者高于首次骨折患者,差异均有统计学意义(P<0.05)。结论 (1)骨折后,机体内凝血系统被激活,血液处于高凝状态;(2)有骨折手术史的二次骨折患者,血液的凝血状态高于首次骨折患者;(3)骨折后,有效监测患者的血沉、血浆和全血粘度的变化,对预防患者发生深静脉栓塞具有一定的指导作用。

Objective To study the differences of hemorrheology between the secondary fracture patients,first fracture patients and the healthy persons,and to explore the influence of fracture history on thrombosis,so as to provide reference to prevent thrombosis. Methods The hemorheology indicators,coagulation indicators,hemodynamic indicators,serum D-dimer content and lower limb vascular color Doppler ultrasonography were compared between 30 cases secondary fracture patients ,100 cases first fracture patients and 80 healthy persons. Results ⑴Except hematocrit,the differences of hemorheology indicators and coagulation indicators between the three groups were statistically significant（P〈0.05）;Hemodynamic indicators had no statistical significant dif-ferences （P〉0.05）. All the hemorheology indicators in the fractures patients were higher than those in healthy persons and what in secondary fracture patients were higher than those in first fracture patients（P〈0.05）. ⑵The prothrombin time（PT）,activated partial clotting enzyme live time （APTT） and thrombin time （TT） in the fractures patients were shorter than those in healthy persons and what in secondary fracture patients were shorter than those in first fracture patients（P〈0.05）. ⑶The fibrinogen（FIB） concentration, serum D-dimer concentration and incidence of lower extremity deep vein thrombosis in the fractures patients were higher than those in healthy persons and what in secondary fracture patients were higher than those in first fracture patients ,all the differences had statistical significance （P〈0.05）. Conclusion （1）The blood of traumatic fracture patients were in high coagulation state. （2） Secondary fracture patients were in a higher state,fracture surgery history lead to a high condensation blood state. （1）The whole blood viscosity,plasma viscosity,blood sedimentation were sensitive indicators for judging the blood of traumatic fracture patients was in high coagulation state. Monitoring the whole blood viscosity,plasma viscosity,blood sedimentation in patients with fracture would be significant for prevention of deep vein thrombosis （DVT） and pulmonary embolism （PE）.