骨盆骨折内固定术中应用普通肝素对术后下肢深静脉血栓发生率的影响

Influence of Intraoperative Application of Unfractionated Heparin on the Deep Vein Thrombosis in Patients Undergoing Pelvic Fracture Fixation

目的观察术中应用普通肝素对骨盆骨折内固定术后下肢深静脉血栓(deep venous thromboembolism,DVT)的影响。方法纳入2012年8月至2014年8月期间67例行内固定术的不稳定性骨盆骨折(均为Tile分型C型)患者,随机分为研究组(n=34)、对照组(n=33)。研究组术中静脉滴注普通肝素;对照组术中按常规处理,未静脉滴注普通肝素。术后1、3、5、7d采用多普勒超声探测双下肢深静脉有无血栓形成检测,评估术后7天下肢DVT发生率;并检测术后1、3、5、7d血浆D-二聚体浓度;观察记录两组患者术中出血量及输血量。结果两组患者术中出血量及输血量差异无统计学意义。研究组术后7d下肢DVT率低于对照组差异有统计学意义(5/34,11/33,P<0.05)。术后研究组血浆D-二聚体浓度低于对照组差异有统计学意义(P<0.05),研究组术后1、3d血浆D-二聚体浓度低于对照组差异有统计学意义(P<0.05),术后5、7d两组患者血浆D-二聚体浓度无统计学意义。结论骨盆骨折内固定手术术中应用肝素可以降低术后7d下肢DVT发生率,降低术后早期血浆D-二聚体浓度,对术中出血量无明显影响。

Objective The present study was aimed to explore the influence of intraoperative application of unfractionated heparin on the deep vein thrombosis（ DVT） in patients undergoing pelvic fracture fixation. Methods During October of 2011 to April of 2014,a total of 67 patients who received pelvic fracture fixation were recruited. All the participants were randomly assigned into 2 groups,the study group（ n = 34） and the control group（ n = 33）. Patients in study group received unfractionated heparin during surgery,while patients in control group receive none. All patients underwent pelvic fracture fixation under general anesthesia. Incidence of DVT within 7 days after surgery were detected with Doppler ultrasound through examining the deep venous in both lower limb 1,3,5,7 days after surgery. The level of D-dimer in plasma was measured 1,3,5,7 days after surgery. Data on blood loss during surgery was recorded. Results There was no significant difference in intraoperative blood loss between two groups. Incidence of DVT within 7 days after surgery in study group was lower than that in control group（ 5 /34 versus 11 /33,P〈0. 05）,as well as the level of D-dimer in plasma（ P〈0. 05）. The levels of D-dimer in plasma at 1,3 days after surgery in study group were lower than that in control group,while no difference was found in the levels of D-dimer in plasma at 5,7 days after surgery between groups. Conclusion Intraoperative application of unfractionated heparin could decrease the incidence of DVT within7 days after surgery in lower limbs,and reduce the levels of D-dimer in plasma after surgery,without significant influence on the blood loss during the surgery.