活血化瘀复合低分子肝素对不同年龄段高龄骨伤患者抗血栓疗效分析

Curative Analysis of Using Activating Blood and Dissolving Stasis Combined with Small Molecule Compound of Heparin in Age-related Groups of Old Orthopedic Patients

目的：观察围手术期应用活血化瘀复合低分子肝素钙对不同年龄段高龄骨伤患者抗血栓治疗疗效的分析。方法：选择ASAⅠ~IV级,年龄≥60岁,髋部骨折择期行髋关节置换手术的患者120例,按照不同年龄段分为N1组（60~69岁）、N2组（70~79岁）、N3组（≥80岁）,每组再随机分为研究组及对照组（N1分为N1y和N1d,N2为N2y和N2d,N3分为N3y和N3d）,每小组各20例。研究组入院即开始口服＂七味三七口服液＂（10ml,每日3次）,手术当日停用,术后第2天继续服用至术后10天结束。所有病例于伤后1天以及术毕（术中停用）12小时以后应用低分子肝素钙抗凝治疗直至出院,用法为3075AXa IU/日、皮下注射。分别记录入院时（T0）、手术当日（T1）及术后10天（T2）测定D-二聚体（D-Dimer）、GMP140的值。结果：所有研究组（N1y、N2y、N3y）T1、T2D-D值明显低于T0（P〈0.05）,但T1、T2之间比较无明显差异,N1y、N2y、N3y在T0、T1、T2时各组之间D-D值比较无明显差异。所有研究组（N1y、N2y、N3y）随着治疗时间的延长GMP140浓度逐渐见降低,T2GMP140值明显低于T0（P〈0.05）,但T1、T2之间比较无明显差异。在T0时,研究组和对照组GMP140值随着年龄的增加GMP140浓度逐渐升高,N3y〉N2y〉N1y,N3d〉N2d〉N1d有明显差异（P〈0.05）,但在T1、T2时无明显差异。结论：初步研究发现随着年龄的增加,GMP140浓度越高,越容易形成血栓。应用活血化瘀复合低分子肝素钙对不同年龄段高龄骨伤患者治疗都能有效减少血栓前状态形成,能有效预防深静脉血栓的发生,而且对年龄越高的患者效果越好。

Objective： The goal was to analyze the antithrombotic therapy efficacy of the small molecule compound of heparin calcium in age-related groups of old orthopedic patients during perioperative period. Methods： We enrolled a total of 120 patients with hip fractures appropriate for hip replacement surgery,American Society of Anaesthesiologists（ ASA） gradeⅠ ~ IV and ages≥60. Patients were separated in different groups based on the age： N1（ ages of 60 ~ 69）,N2（ ages of 70 ~ 79） and N3（ ages≥80）. Patients in each group were randomly divided into study and control（ N1 divided into N1 y and N1 d,N2divided into N2 y and N2 d,N3divided into N3 y and N3d）. Each study and controlled group had 20 patients. Patients in the study group began orally taking 10 ml Qiwei Sanqi Oral Liquid,tid,stopping oral administration on the day of surgery,and resumed it on the next day until 10 days post surgery. All of the patients started the treatment of small molecule compound of heparin calcium from one day after injury and 12 hours post surgery（ stop it in operation） until hospital discharge,3075 AXa IU / day,subcutaneous injection. The value of D-Dimer and GMP140 was measured on the day of admission to hospital（ T0）,surgery（ T1）,as well as10 days post surgery（ T2）. Results： The D-D value of T1 and T2in the study groups（ N1 y,N2y,N3y） was significantly lower than T0（ P〈0. 05）,but the differences between T1 and T2were not significant. There was also no significantly difference in T0,T1 and T2. The concentration of GMP140 gradually deceased as the treatment was undergoing,and the value of GMP140 at T2was significantly lower than that of T0（ P〈0. 05）, but the difference between T1 and T2was not significant. The GMP140 value at T0 was progressively increased in both study and controlled groups with the increasing aging,N3 y〉 N2y〉 N1y,N3d〉N2d〉N1d（ P〈0. 05）,but the value of GMP140 was not significantly different at T1 and T2. Conclusions： It is easier to result in thrombus when the concentration of GMP140 was increased with the increasing ages. Small molecule compound of heparin calcium can effectively to reduce the formation of prethrombotic state in different groups of old orthopedic patients,and can effectively prevent the deep vein thrombus. It has better efficacy in the older patients.