糖尿病患者TKA术后早期凝血状态变化趋势及其临床意义

The trend and clinical significance of blood coagulation state in patients with diabetes after TKA operation

目的观察膝关节骨性关节炎合并糖尿病患者初次TKA术后早期凝血状态变化趋势,旨在为其围手术期抗凝治疗提供临床指导。方法选择2014年12月至2016年12月在广州市第一人民医院关节外科住院诊断为骨性关节炎,并行初次单侧TKA手术的患者60例。入院时检测空腹血糖水平,根据空腹血糖水平及病史情况,将患者分为两组:糖尿病患者组及空腹血糖正常组。两组患者均为30例,年龄60~85岁,糖尿病组平均69.70±4.69岁,男5例,女25例。正常人组平均72.70±5.36岁,男4例,女26例。两组于围手术期给予相同的临床干预、治疗,分别于术前、术后第1天、第3天、第7天清晨空腹采集肘前静脉血液标本,检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、以及血小板计数(PLT)等指标的变化。结果两组患者术后血液中Fib含量变化的趋势均为术后第1天开始升高,在术后第3天时达到峰值(糖尿病组=5.25±0.82 g/L,正常人组=4.44±0.43 g/L),虽然术后第7天较术后第3天有所下降,但较术前水平仍有上升,有统计学差异(P<0.05),而且糖尿病组患者血液中Fib指标在术后各个时间点均较正常人组偏高(P<0.05)。两组患者术后血液PLT计数的变化趋势基本一致,无统计学差异。术后第1天较术前有明显下降,术后第3天下降到最低值(糖尿病组=203.60±41.02/L,正常人组209.80±55.47/L),术后第7天时两组患者PLT计数恢复到术前水平。两组患者术后血液TT、APTT、PT值均在正常范围内波动,无明显变化趋势,不存在统计学差异。结论初次单侧TKA术后,膝关节骨关节炎伴糖尿病患者血液的高凝状态较空腹血糖正常的患者更为严重。Fib是检测高凝状态的敏感指标,术后监测Fib指标的变化有利于对评估膝关节骨关节炎患者TKA术后的凝血状态。

Objective To investigate the changes of blood coagulation status in patients with osteoarthritis of knee joint with diabetes after primary TKA. Methods A total of 60 patients with osteoarthritis were included in the research object in December 2014 to December 2016 from our hospital and underwent primary TKA surgery. According to fasting blood glucose level and history,patients were divided into two groups：diabetic group（30 cases） and normal group（30 cases）. The patients in diabetes group had average 69.70±4.69 years old,5 males and 25 females. In the normal group,theaverage age was 72.70±5.36 years,4 males and 26 females. The two groups were given the same clinical intervention and treatment during the perioperative period. The blood specimens of the anterior elbow vein were collected on the fasting morning in the first,the third,and seventh days to detect the changes of prothrombin time（PT）,activated partial thromboplastin time（PTT）,thrombin time（TT）,fibrinogen（FIB）,and blood platelet（PLT）. Results The postoperative Fib change trend in two groups were are risen in the postoperative 1 st day,3 rd day to the peak（diabetes group=5.25±0.82 g/L,normal group=4.44 ± 0.43 g/L）. While the Fib level in the postoperative day 7 were was less than postoperative 3 rd day,but still more than preoperative level（P〈0.05）. Blood Fib in diabetes group was high than the normal group in all time points（all P values 〈0.05）. The change trend of blood PLT counts in both groups was basically the same,and. The PLT level on the first postoperative day was significantly lower than before surgery,and dropped to the lowest value on the third postoperative day. At the seventh postoperative day,the PLT count of both groups was restored to the preoperative level. And there were no statistical differences at each time point of PLT count（all P values〈 0.05）. In both group,PLT,PT and APTT did not change significantly preoperative and postoperatively. Conclusion After primary unilateral TKA,hypercoagulability of blood in patients with knee osteoarthritis and diabetes is more severe than that in patients with normal fasting blood glucose. Fib is a sensitive index for detecting hypercoagulable state. Postoperative monitoring of changes in Fib index is helpful for evaluating the coagulation state of patients with knee osteoarthritis after TKA.