手术前后血流流变学、血流动力学参数变化对全髋关节置换术后管理的指导价值

Value of changes of hemorheology and hemodynamics parameters before and after total hip arthroplasty on postoperative management

背景:全髋关节置换术(THA)后易发生下肢深静脉血栓形成(DVT),DVT与血液黏度及流速有关。目的:探讨术前及术后血流流变学、血流动力学参数变化对THA术后管理的指导价值。方法:前瞻性选取2017年1月至2018年12月行THA治疗的61例患者作为研究对象,分别监测患者术前、术后1 h及术后1 d的血流流变学和血流动力学参数。根据术后是否出现DVT分为DVT组24例和非DVT组37例。分析两组临床资料和围手术期血流流变学、血流动力学的参数差异。结果:DVT组与非DVT组的性别、年龄、ASA分级、体重指数(BMI)、术中失血量、术中输液量、术中输血量、手术时间等一般资料比较,差异均无统计学意义(P>0.05)。DVT组术前、术后1 h、术后1 d的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、纤维蛋白原(FIB)、红细胞压积(HCT)、红细胞聚集指数、血浆黏度、全血高切黏度、全血中切黏度、全血低切黏度与非DVT组比较,差异均无统计学意义(P>0.05)。DVT组及非DVT组术后1 h、术后1 d的MAP、HR、CVP、FIB、HCT、红细胞聚集指数、血浆黏度、全血高切黏度、全血中切黏度、全血低切黏度与术前比较,差异均有统计学意义(P<0.05)。DVT组的MAP、HR、CVP、FIB、HCT、红细胞聚集指数、血浆黏度、全血高切黏度、全血中切黏度、全血低切黏度的△1、△2、△3(△1=术后1 h-术前,△2=术后1 d-术前,△3=术后1 d-术后1 h)与非DVT组比较,差异均有统计学意义(P<0.05)。结论:THA术后会出现一定程度的血液黏稠度增加、血流速度缓滞的现象,需要密切关注THA术后血液黏稠度、血流速度较术前改变幅度较大者或改变幅度仍在进一步扩大者,必要时应采取有效的干预措施。

Background:Deep vein thrombosis(DVT)of lower extremity is easy to occur after total hip arthroplasty(THA),DVT formation is related to blood viscosity and blood flow rate.Objective:To explore the value of changes in hemorheology and hemo dynamics parameters before and after total hip arthroplasty on postoperative management.Methods:A total of 61 patients who un derwent total hip arthroplasty in our hospital from January 2017 to December 2018 were enrolled and divided into two groups as 24 patients with DVT(DVT group)and 37 patients without DVT(non DVT group).The hemorheology and hemodynamics of pa tients before operation,1 hour after operation and 1 day after operation were monitored and compared between the two groups.Re sults:There was no significant difference in sex,age,ASA classification,body mass index(BMI),intraoperative blood loss,intra operative infusion volume,intraoperative blood transfusion volume and operation time between DVT group and non-DVT group(P>0.05).There was no significant difference in mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),fi brinogen(FIB),hematocrit(HCT),erythrocyte aggregation index,plasma viscosity,whole blood high shear viscosity,whole blood medium shear viscosity and whole blood low shear viscosity before operation,1 hour and 1 day after operation between DVT group and non-DVT group(P>0.05).There were significant differences in MAP,HR,CVP,FIB,HCT,erythrocyte aggregation in dex,plasma viscosity,whole blood high shear viscosity,whole blood shear viscosity and whole blood low shear viscosity at 1 hour and 1 day after the operation compared with before operation in both group(P<0.05).There were significant differences in△1,△2 and△3(△1=1 hour after operation–before operation,△2=1 day after operation-before operation,△3=1 day after opera tion-1 hour after operation)of MAP,HR,CVP,FIB,HCT,erythrocyte aggregation index,plasma viscosity,whole blood high shear viscosity,whole blood medium shear viscosity,whole blood low shear viscosity between DVT group and non-DVT group(P<0.05).Conclusions:After THA,the blood viscosity increases and the blood flow velocity slows down to some extent.Therefore close attention should be paid to the patients with relatively great changes or still growing changes of blood viscosity and blood flow velocity after THA compared with before operation,and effective interventions should be taken when necessary.