低分子肝素钙联合前列地尔对老年全髋置换术患者围手术期下肢深静脉血栓的预防作用

Preventive Effect of Low Molecular Weight Heparin Calcium Combined with Alprostadil on Perioperative Lower Extremity Deep Venous Thrombosis in the Elderly Undergoing Total Hip Replacement

目的探讨老年全髋置换术患者使用低分子肝素钙联合前列地尔对于预防围手术期下肢深静脉血栓的作用。方法选取2014年1月-2018年1月在上海市公共卫生临床中心骨科诊治的全髋置换术患者88例作为研究对象。将所选患者随机分为对照组和观察组,每组44例;对照组采取低分子肝素钙治疗,观察组在对照组相同的治疗基础上予前列地尔治疗。观察2组患者下肢深静脉血栓的发生率、术中出血量、术后引流量以及血红蛋白、血小板以及D-二聚体指标的变化情况并进行比较。结果观察组术后下肢深静脉血栓发生率为6.8%,对照组术后下肢深静脉血栓发生率为9.1%,组间比较差异无统计学意义(>0.05);2组患者术中出血量、术后引流量情况及治疗前各项指标及各时间点血小板水平比较均无统计学差异(>0.05)。术后1 d及术后10 d,2组血红蛋白水平均明显低于术前(<0.05),但术后1d与10 d组间比较差异无统计学意义(>0.05);而治疗后观察组患者的D-二聚体低于治疗前(<0.05)。结论在全髋置换术患者围手术期,应用低分子肝素钙联合前列地尔治疗对预防下肢深静脉血栓发生的作用并不优于单独使用低分子肝素钙,但能更显著降低血清D二聚体水平,且不会增加相应并发症发生,不影响患者的血红蛋白水平。

Objective To invcstigatc thc cffcct of low molccular wcight hcparin calcium combincd with alprostadil in the prevention of perioperative lower extremity deep venous thrombosis in the elderly undergoing total hip replacement. Methods 88 cases undergoing total hip replacement during the period from Jan., 2014 to Jan., 2018 were selected and randomly divided into 2 groups： observation group and control group, 44 in each; low molecular heparin calcium was given to all the cases in both group while combined application of alprotadil was added to cases in observation group; the occurrence of low extremity deep venous thrombosis, the bleeding volume in operation, the drainage volume after operation and the changes of the levels of hemoglobin, platelet and D-dimer were observed, and a comparative study was made between the 2 groups. Results The occurrence of lower extremity deep venous thrombosis in observation group was 6.8% while that was 9.1% in control group, the difference was of no statistical significance （P〉0.05）; there existed no statistical difference in bleeding volume in operation, the drainage volume after operation, each index before operation and the level of platelet at each time point between the 2 groups; the levels of hemoglobin in the 2 groups on the 1st, the 10th day after operation were much lower than those before operation （P〈0.05） while no difference was found on the 1st, the 10th day after operation between the 2 groups （P〉 0.05）; after treatment, the level of D-dimer of the cases in observation group was lower than that before treatment （P〈0.05）. Conclusions The combined application of low molecular weight heparin calcium and alprostadil during the perioperative period is not of superior preventive effect to the single application of low molecular weight heparin calcium, but it can obviously decrease the level of serum D-dimer without increasing the occurrence of related complication and affecting the level of hemoglobin.