两种抗凝药物对股骨粗隆骨折术后血液流变学的影响

Effect of two anticoagulant drugs on postoperative haemorheology in the elderly patients with intertrochanteric femoral fractures treated by PFNA

[目的]探讨阿哌沙班和依诺肝素对老年股骨粗隆间骨折PFNA内固定术后血液流变学的影响。[方法]前瞻性收集暨南大学附属江门中医院行闭合复位PFNA内固定治疗的老年股骨粗隆间骨折患者68例,随机分为阿哌沙班组和伊诺肝素组,每组34例。所有患者均在腰硬联合麻醉下进行手术,记录所有患者术中及术后第1、2 d的输液量、出血量及尿量,术前和术后第1周两组患者的血液流变学指标。[结果]阿哌沙班组术后第1周的血浆黏度、红细胞比容、红细胞变形指数、血浆纤维蛋白原水平与术前相比差异无统计学意义(P>0.05),伊诺肝素组在术后第1周的血浆黏度、红细胞变形指数、血浆纤维蛋白原水平均显著高于伊诺肝素组术前水平和阿哌沙班组术后水平,差异有统计学意义(P<0.05)。[结论]对于老年股骨粗隆间骨折行闭合复位PFNA内固定术的患者,阿哌沙班较依诺肝素更有利于血液流变学指标的改善,可作为减少术后血栓性并发症的有效措施之一。

[Objective] To evaluate the effect of apixaban and enoxaparin on postoperative haemorheology in the elderly pa- tients with intertrochanteric femoral fractures treated by PFNA. [Methods] A prospective study was conducted on 68 elderly pa- tients with intertrochanteric femoral fractures treated surgically by closed PFNA in our hospital. In term of anticoagulant drug re- ceived, the patients were equally and randomly divided into two groups, the apixaban group and the enoxaparin group with 34 patients in each group. All the patients underwent closed reduction and internal fixation with PFNA under combined spinal and epidural anesthesia. The amount of infusion, the amount of bleeding and the volume of urine were recorded at the first and sec- ond day after operation, additionally the hemorheological parameters of the two groups were measured at l week before and after operation. [Results] In the apixaban group, the plasma viscosity, hematocrit, deformed index of red blood cell and levels of plas- ma fibrinogen at 1 week postoperatively proved no statistical difference with those 1 week preoperatively （P〉0.05）. However, in the enoxaparin group the plasma viscosity, erythrocyte deformation index, raw plasma fibrin at 1 week after operation were sig- nificantly higher than those in the enoxaparin group preoperatively, and those in the apixaban group postoperatively, with statis- tically significant differences （P〈0.05）. [Conclusions] For the elderly patients with intertrochanteric femoral fractures received closed reduction and internal fixation with PFNA, the apixaban is superior to the enoxaparin in improvement of haemorheology, Therefore, the former might be used as more powerful measure to prevent thrombosis and related complications over the latter.