老年髋部骨折患者围手术期抗凝治疗时间窗分析

An analysis of time window for perioperative anti-coagulation treatment in elderly patients with hip fracture

目的探讨不同治疗时间窗对老年髋部骨折患者围手术期抗凝效果的影响。方法将126例老年髋部骨折患者分为急性期抗凝组(A组,41例)、术前抗凝组(B组,44例)和术后抗凝组(C组,41例)。观察各组围手术期凝血指标的动态变化,并记录随访期内静脉血栓栓塞症(VTE)的发生情况。结果各组凝血酶原时间和活化部分凝血活酶时间在围手术期均稳定在正常范围,未发生明显变化(P>0.05)。各组凝血酶时间虽然也维持在正常范围内,但A组术后3d较入院时降低[(17.48±1.29)s vs.(18.51±1.91)s](P<0.05)。各组D-二聚体均呈现出逐渐下降趋势,A组和B组术后3d较入院时降低[(5.25±5.05)mg/L vs.(11.26±9.99)mg/L和(4.95±3.38)mg/L vs.(10.90±8 76)mg/L](P<0.05)。随访3个月,A组未发生VTE,B组VTE发生率低于C组(2.27%vs.14.63%)(P<0.05)。结论治疗时间窗能够影响老年髋部骨折患者围手术期抗凝的效果,急性期抗凝的效果最佳。

Objective To investigate the effect of different time windows on perioperative anticoagulation treatment in elderly patients with hip fracture.Methods A total of 126 elderly patients with hip fracture was divided into three groups,who were treated with anti-coagulation during acute stage(group A,41 cases),before operation(group B,44 cases)and after operation(group C,41 cases),respectively.The changes of perioperative coagulation indexes were detected and the occurrence of venous thromboembolism(VTE)was recorded.Results The prothrombin time and activated partial thromboplastin time in three groups were stable in normal range perioperatively(P>0.05).The thrombin time was also in normal scale in three groups,but on the 3rd day after operation in group A was lower than that on admission[(17.48±1.29)s vs.(18.51±1.91)s](P<0.05).Moreover,D-dimer in three groups presented a declining tendency,which in groups of A and B was lower on the 3rd day after operation than that on admission [(5.25±5.05)mg/L vs.(11.26±9.99)mg/L and(4.95±3.38)mg/L vs.(10.90±8.76)mg/L](P<0.05).The patients were followed up for three months,which showed that VTE was not found in group A and the incidence of VTE was lower in group B than that in group C(2.27% vs.14.63%)(P<0.05).Conclusion The time windows for anti-coagulation treatment can affect the therapeutic efficacy in elderly patients with hip fracture,in which better efficacy can be obtained when anti-coagulation is performed in acute stage of hip fracture.