髋关节置换后下肢深静脉血栓形成的血液动力学改变

Hemodynamic changes in lower extremity deep vein thrombosis after total hip replacement

背景:髋关节置换后下肢深静脉血栓的早期诊断非常重要,对及时治疗及疗效判断也具有十分重要的意义。目的:观察髋关节置换后并发下肢深静脉血栓患者的血液改变情况,为早期预测和干预提供参考。方法:2009年1月至2014年9月收治60例髋关节置换患者,其中置换后并发下肢深静脉血栓者32例(下肢深静脉血栓组),未并发下肢深静脉血栓者28例(非下肢深静脉血栓组)。分别于置换后1,3,5 d检测患者的血流变指标改变情况。结果与结论:通过检测显示,下肢深静脉血栓组置换后各种凝血标记物均异常高于非下肢深静脉血栓组,表明置换后患者的血液高凝状态度与下肢深静脉血栓的发生有密切相关的关系;而下肢深静脉血栓组置换后3,5 d D-二聚体、纤维蛋白原水平显著高于非下肢深静脉血栓组,说明D-二聚体、纤维蛋白原水平的增高与置换后发生下肢深静脉血栓呈正相关关系,提示对髋关节置换后应对患者进行动态的血液监测,如果各检测结果呈持续性增高,则应怀疑是否有血栓的发生,并及早采取预防措施。

BACKGROUND： It is very important to early diagnosis of lower extremity deep vein thrombosis after total hip replacement, which also has very important meaning for the timely treatment and judging the curative effect. OBJECTIVE： To study the blood changes of the patients complicated with lower extremity deep vein thrombosis after hip joint replacement, so as to provide the reference for the early prediction and intervention. METHODS： Among 60 cases of hip joint replacement patients who received the treatment from January 2009 to September 2014, there were 32 cases of postoperative patients complicated with lower extremity deep vein thrombosis（lower extremity deep vein thrombosis group）, 28 cases without concurrent lower extremity deep vein thrombosis（non-lower extremity deep vein thrombosis group）. The change of the blood rheology index of patients was detected at the 1^st, 3^rd, 5^th days after hip joint replacement. RESULTS AND CONCLUSION： The detection results showed that the various coagulation markers in the lower extremity deep vein thrombosis group after the replacement were abnormally higher than those in the non-lower extremity deep vein thrombosis group, which showed that the hypercoagulability attitudes of patients after hip joint replacement closely related to the occurrence of lower extremity deep vein thrombosis, however, the Ddimer and fibrinogen levels of patients at the 3rd and 5th days after hip joint replacement in lower extremity deep vein thrombosis group were significantly higher than non-lower extremity deep vein thrombosis group, which showed that the increase of D- dimer and fibrinogen levels was positively correlated with the occurrence of lower extremity deep vein thrombosis after hip joint replacement. These results suggest that patients should undergo dynamic blood monitoring after hip joint replacement. If the test results were continuously increased, we should doubt whether the occurrence of thrombosis, and then take preventive measures as early as possible.