急性下肢骨折合并深静脉血栓形成患者治疗后凝血指标的变化

Alternations of blood coagulation indexes in patients with acute lower limb fractures combined with deep venous thrombosis after treatment

目的探讨急性下肢骨折合并深静脉血栓形成(DVT)患者治疗后凝血指标的变化。方法收集2019年1月至2020年6月北京积水潭医院收治的102例急性下肢骨折患者的临床资料。根据治疗方式不同分为联合组(n=51,经导管接触性溶栓治疗联合抗凝治疗)和抗凝组(n=51,单纯抗凝治疗)。联合组患者在治疗前、治疗后3 d和治疗后7 d检测凝血指标[D-二聚体、纤维蛋白原(Fib)及纤维蛋白降解产物(FDP)];抗凝组患者于治疗前和治疗后7 d抽血检测相同凝血指标;统计治疗期间并发症发生情况。结果治疗后,两组患者D-二聚体、Fib和FDP水平均低于治疗前;抗凝组患者的Fib水平高于联合组患者;联合组治疗后3 d D-二聚体和FDP表达水平最高,治疗后7 d Fib表达水平高于治疗后3 d,差异有统计学意义(P<0.05)。治疗期间,两组患者均未发生大出血、肺栓塞和死亡等不良事件。结论采用尿激酶联合经导管接触性溶栓治疗急性下肢骨折合并DVT的患者,需检测凝血指标的变化。

Objective To investigate the changes of blood coagulation indexes in patients with acute lower limb fractures combined with deep venous thrombosis(DVT)after treatment.Method The clinical data of 102 patients with acute lower limb fractures admitted to Beijing Jishuitan Hospital from January 2019 to June 2020 were collected.According to different treatment methods,they were divided into combined group(n=51,catheter-directed thrombolysis combind with anticoagulant therapy)and anticoagulant group(n=51,anticoagulant therapy alone).Coagulation indexes[D-dimer,fibrinogen(Fib)and fibrin degradation products(FDP)]were measured before treatment,3 d and 7 d after treatment in the combination group;the same coagulation indicators were also detected in the blood samples drawn from the anticoagulation group before and after treatment 7 d.The occurrence of complications during treatment were also counted.Result After the treatment,the D-dimer,Fib and FDP of the two groups of patients were lower than before treatment.The Fib of the anticoagulation group was higher than that of the combination group.The expression levels of D-dimer and FDP of the combination group were the highest on the 3rd day after treatment,and the Fib expression level on the 7th day after treatment was higher than that on the 3rd day after treatment.The differences were statistically significant(P<0.05).During the treatment period,no adverse events such as hemorrhage,pulmonary embolism,or death in the two groups were reported.Conclusion It is necessary to detect alternations in coagulation indicators when taking the regimen containing urokinase combined with catheter-directed thrombolysis in the treatment of patients with acute lower extremity fractures and DVT.