血栓弹力图评价粗隆间骨折不同抗凝起点的凝血功能改变

The changes of blood coagulation by thromboelastography in intertrochanteric fracture patients with different timing of anticoagulant therapy initiation

目的观察粗隆间骨折患者不同抗凝起点的凝血功能变化。方法选取我院2012年7月~2015年12月收治的粗隆间骨折患者216例,随机分为术前抗凝组(108例)和术后抗凝组(108例);选择同期我院健康体检者40名为对照组。术前抗凝组入院后即开始给予低分子肝素钙抗凝,术前24小时停药,术后第1天恢复使用至第5周;术后抗凝组于术后第1天开始抗凝直至第5周。两患者组于入院时、入院第4天、术后第1天、第1、3、5周分别进行血栓弹力图检测,对照组仅于查体当天进行检测。结果两患者组入院时与对照组相比呈高凝状态。术后抗凝组高凝状态在术前呈逐渐加重的趋势,且在术后第1天再次显著增加;抗凝治疗1周后高凝状态得到较好纠正,其后凝血功能趋于平稳直至抗凝治疗第5周。术前抗凝组高凝状态在入院第4天已得到显著改善,术后第1天凝血功能仅有轻度增强,再次经过抗凝治疗1周后高凝状态得到较好纠正,直至抗凝治疗第5周。两组粗隆间骨折患者在抗凝治疗终点时(5周),凝血功能状态与对照组基础值类似,没有"矫枉过正"。结论粗隆间骨折患者呈高凝状态,入院后早期抗凝治疗能改善高凝状态,且不会明显增加出血风险。

Objective To observe the changes of blood coagulation by thromboelastography in intertrochanteric fracture patients with different timing of anticoagulant therapy initiation. Methods 216 intertrochanteric fracture patients, who were recruited in our hospital from Ju12012 to Dec 2015, were randomly assigned to preoperative anticoagulation group （n=108） and postoperative anticoagulation group （n=108）. In preoperative anticoagulation group, the patients received treatment of low-molecular-weight heparin calium from the day of hospitalization to 24 h before the surgery, and the anti- coagulation therapy was reinitiated at 1 days after surgery. In postoperative anticoagulation group, the patients received anticoagulation therapy at 1 days after surgery. All patients were treated with anticoagulation therapy lasted 5 weeks after the surgery. Meanwhile, 40 health examination participants were selected as the control group. For all intertrochanteric fracture patients, the thromboelastography （TEG） were tested at admission, 4 days after admission, 1 days after surgery, 1 week, 3 and 5 weeks after surgery respectively, while the control group participants were tested on the day of health examination. Results All intertrochanteric fracture patients were in hypercoagulable state at admission, compared with control group. For postoperative anticoagulation group, the hypercoagulability become worse step by step with a sig- nificant increase on day 1 after surgery. After 1 week anticoagulation therapy, the hypercoagulability was palliative and maintained till 5 weeks after surgery. For preoperative anticoagulation group, the hypercoagulability was remedied at 4 days after admission with a mild increase at 1 day after surgery. After another 1 week anticoagulation therapy, the hy- percoagulability was palliative and maintained till 5 weeks after surgery. And, the blood coagulation had no significant difference for intertrochanteric fracture patients compared with control group at 5 weeks after surgery. Conclusion The intertrochanteric fracture patients were in hypercoagulable state. Giving early anticoagulation therapy could rectify the hypercoagulability without increasing the risk of bleeding.