术前应用低分子肝素对预防老年髋关节置换术后深静脉血栓形成的安全性与有效性研究

Satety and effectiveness of preventing postoperative deep venous thrombosis of the elderly hip replacement by applying low molecular weight heparin preoperatively

目的观察术前应用低分子肝素钙（low molecular weight heparin calcium injection,LMWH）预防人工髋关节置换术后深静脉血栓形成的安全性、有效性。方法选取山西省某煤矿三甲医院2014年1月~2015年12月期间符合标准的60例人工髋关节置换术后患者为研究对象,并随机分为两组。试验组：给予腹部皮下注射低分子肝素钙5000 IU。术后每天皮下注射1次,剂量同术前,共治疗7 d。对照组：术前不采用任何预防方法,术后处理同试验组。检测术后输血量、血小板计数、术后引流量、红细胞、血红蛋白、活化部分凝血酶原时间、彩色多普勒检测深静脉血栓、患者术后DVT发生率。结果试验组1例发生深静脉血栓,对照组6例发生深静脉血栓,两组下肢深静脉血栓发生率比较,差异有统计学意义（P〈0.05）;两组术后输血量、血小板计数、血红蛋白、活化部分凝血酶原时间等比较,差异均无统计学意义（P〉0.05）。结论术前应用低分子肝素钙可为预防老年患者人工髋关节置换术后深静脉血栓的发生提供了一种安全、有效的措施。

Objective To observe the safety and the effectiveness of preventing postoperative deep venous thrombosis（deep venous thrombosis, DVT） of hip replacement（total hip replacement, THR） by applying low molecular weight heparin（low molecular weight heparin calcium injection, LMWH） preoperatively. Methods The subjects were 60 qualified patients being performed an artificial hip replacement surgery from a top three hospital of a coal mine in Shanxi Province from January 2014 to December 2015 and they were divided into two groups randomly. Experiment group： The abdominal subcutaneous injection was low molecular weight heparin 5000 IU postoperatively once a day with the same dose as the preoperation within seven days of treatment. Control group： No preoperative prophylaxis was used and the postoperative management was the same with the experiment group. And then the amount of postoperative bleeding,platelets, drainage volume, red blood cell, hemoglobin, activated partial thromboplastin time, color Doppler detection of deep vein thrombosis, postoperative incidence of DVT patients were detected. Results There was one case of deep vein thrombosis in the experiment group while six cases in the control group. The difference of deep venous thrombosis in cidence was statistically significant between the two groups（P〈0.05）; There were no significant differences of postoperative bleeding amount, platelets, hemoglobin, activated partial thromboplastin time（P〉0.05）. Conclusion It is a safe and effective way to prevent elderly patients＇ deep vein thrombosis of the postoperative hip replacement by using low molecular weight heparin calcium injection.