低分子肝素对老年人大腿骨折术前静脉血栓预防作用的前瞻性队列研究

A prospective cohort study on effect of low molecular weight heparin to prevent aged patients with femoral fractures from venous thrombosis before surgical treatment

目的观察老年人大腿骨折患者术前使用低分子肝素预防静脉血栓形成的疗效。方法采用前瞻性队列研究自2012-07—2014-07年龄≥65岁的大腿闭合性骨折,根据入院后主管医师是否使用低分子肝素分为暴露组和非暴露组,使用低分子肝素者为暴露组,未使用低分子肝素者为非暴露组。研究结束时暴露组40例,非暴露组21例。术前1 d或者当天行双下肢彩色多普勒超声检查,将结果分为无静脉血栓、肌间静脉血栓及深静脉血栓3个等级,然后对2组数据进行统计学分析。结果经双下肢彩色多普勒超声检查,2组无静脉血栓、肌间静脉血栓及深静脉血栓例数采用秩转换检验,差异有统计学意义(P=0.027)。如果将结果分为无静脉血栓及有静脉血栓2个级别,那么静脉血栓发病率为31.1%(19/61),暴露组发病率为22.5%(9/40),非暴露组发病率为47.6%(10/21);RR值为0.473,χ2CMH=3.985,P=0.046,95%CI(0.228,0.980)。结论低分子肝素在一定程度上能够预防老年人大腿骨折患者术前静脉血栓形成。

Objective To explore the clinical effect of low molecular weight heparin （LMWI-I） to prevent aged patients with femoral fractures from venous thrombosis before surgical treatment. Methods The prospective cohort studywas carried out from July 2012 to July 2014. All the aged patients （age≥65） with femoral fractures were divided into two groups, the group with LMWH used was regarded as the treatment group and the other group without LMWH as the control group. All the patients underwent a low extremity deep vein color Doppler ultrasound examination on the operation day or 1 day before operation. The outcomes were divided into three levels： no venous thrombosis, Calf muscular venous thrombosis and deep venous thrombosis （DVT）. The outcomes were analyzed with SPSS 17.0. Results There was a significant difference in the color Doppler ultrasound examination outcomes between the two groups. If the outcomes were divided into two levels： no venous thrombosis and venous thrombosis, then the incidence of the venous thrombosis was 31.1%（19/61）, and it was 22.5% （9/40） in the treatment group while was 47.6%（10/21） in the control group. The value of RR was 0.473, χ^2CMH=3.985,P = 0.046 ,95% CI （0.228,0.980）. Conclusion Low molecular weight beparin can prevent aged patients with femoral fractures from venous thrombosis before surgical treatment in a certain degree.