术前应用低分子肝素对中老年髋关节置换术患者术前血液高凝状态及术后下肢深静脉血栓形成的影响

Effects of Low Molecular Weight Heparin on Preoperative Blood Hypercoagulability and Postoperative Deep Venous Thrombosis in Middle-aged and Elderly Patients Undergoing Hip Replacement

目的观察术前应用低分子肝素对中老年髋关节置换术患者术前血液高凝状态及术后下肢深静脉血栓(DVT)形成的影响。方法选取行髋关节置换术治疗的中老年患者74例,按照随机数字表法随机将其分为研究组与对照组,每组各37例,研究组术前48 h给予低分子肝素钙进行治疗,对照组术前未给予任何预防措施。观察比较两组术前及术后7 d血常规指标、凝血功能指标及血浆D二聚体(DD)水平,入院时及术前血栓弹力图(TEG)参数,术中出血量、术后伤口引流量、手术时间及术后7 d DVT发生率。结果两组术前和术后7 d血常规、凝血功能指标及术中出血量、术后伤口引流量、手术时间比较差异均无统计学意义(P>0.05)。术后7 d,血浆DD两组均较术前明显升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术前,研究组反应时间(R时间)、凝固时间(K时间)均较入院时明显延长,凝固角(α角)、血栓最大幅度值(MA值)和血栓硬度值(G值)均较入院时明显降低,差异有统计学意义(P<0.05);对照组R时间、K时间均较入院时明显延长,α角、MA值和G值均较入院时明显降低,差异有统计学意义(P<0.05);研究组R时间明显长于对照组,G值明显低于对照组,差异有统计学意义(P<0.05)。术后7 d,研究组2例发生DVT,DVT发生率为5.41%,对照组8例发生DVT,DVT发生率为21.62%,两组DVT发生率比较差异有统计学意义(P<0.05)。结论术前应用低分子肝素可促进中老年髋关节置换术患者下肢静脉血液回流,改善血液高凝状态,对降低患者术后DVT发生率有积极意义。

Objective To observe the effect of low molecular weight heparin(LMWH)on preoperative blood hypercoagulability and postoperative deep venous thrombosis(DVT)in middle-aged and elderly patients undergoing hip replacement.Methods A total of 74 middle-aged and elderly patients undergoing hip replacement were randomly divided into research group(n=37)and control group(n=37)according to the random number table.The research group was treated with LMWH calcium 48 h before surgery and the control group was not given any preventive measures before operation.The blood routine parameters,coagulation function indexes and DD levels before operation and 7 days after operation in the two groups were observed and compared,TEG parameters at admission and before operation,intraoperative blood loss,postoperative wound drainage,duration of operation,and incidence of DVT at 7 days after operation were compared.Results There were no significant differences in blood routine and coagulation function indexes,intraoperative blood loss,postoperative wound drainage,and duration of operation between the two groups before operation and 7 days after operation(P>0.05).At 7 days after operation,the plasma DD in both groups was significantly higher than that before the operation,which was significantly lower in experimental group than in the control group,and the difference was statistically significant(P<0.05).Before operation,the response time(R time)and coagulation time(K time)in the experimental group were significantly longer than those at admission,andαangle,MA value,and G value were significantly lower than those at admission,showing significant differences(P<0.05);Before operation,the R time and K time in the control group were significantly longer than those at admission,and the anglesα,MA value,and G value were significantly lower than those at admission,suggesting significant differences(P<0.05).The R time in the experimental group was significantly longer than that in the control group,while G value was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).At 7 days after operation,2 patients developed DVT in the experimental group,and the incidence was 5.41%.By contrast,8 patients experienced DVT in the control group,and the incidence was 21.62%.There was a statistically significant difference in the incidence of DVT at 7 days after operation in both groups(P<0.05).Conclusion Preoperative application of LMWH can promote the blood reflux of lower extremities in middle-aged and elderly patients undergoing hip replacement,and improve blood hypercoagulability.Therefore,it is of positive significance to reduce the incidence of postoperative DVT in patients.