血栓弹力图预防股骨颈骨折围手术期深静脉血栓的应用研究

Application of thromboelastography in the prevention of perioperative deep vein thrombosis of femoral neck fracture

目的探究血栓弹力图(TEG)预防股骨颈骨折患者围手术期深静脉血栓(DVT)形成的作用。方法选择2020年1月至2021年7月郑州大学第二附属医院健康体检者30例为对照组,仅做一次TEG检测;髋关节置换术(HA)治疗的股骨颈骨折患者60例为试验组,分别于入院第1天(D1)、术后第1天(D2)、术后第3天(D3)、术后第7天(D4)、术后第10天(D5)行TEG检测,统计两组所得参数进行相关性分析。试验组D5时行下肢静脉彩超,根据结果分为DVT组、非DVT组,使用受试者工作曲线(ROC)分析TEG预防DVT的临床效能。结果对照组TEG各参数均在正常范围。与对照组比较,试验组D1、D2、D3、D4、D5时凝血反应时间(R)、血液凝固时间(K)显著下降,凝固角(α)、最大振幅(MA)、综合凝血指数(CI)值均上升,差异有统计学意义(P<0.05);与D2比较,D3、D4时R、K下降,α角、MA、CI值显著上升,差异有统计学意义(P<0.05);与D3、D4比较,D5时R、K上升,α角、MA、CI值下降,差异有统计学意义(P<0.05)。DVT组与非DVT组,R、K、α角、MA、CI值比较,差异有统计学意义(P<0.05),ROC曲线显示α角、MA、CI预防DVT形成有较高价值。结论TEG可及时评估股骨颈骨折患者围手术期的凝血功能状态,为降低DVT形成风险提供有利的帮助。

Objective To explore the role of thromboelastography(TEG)in preventing perioperative deep vein thrombosis(DVT)in patients with femoral neck fracture.Methods A total of 30 healthy patients undergoing the physical examination in the Second Affiliated Hospital of Zhengzhou University from January 2020 to July 2021 were included in the control group and only underwent one TEG test.A total of 60 patients with femoral neck fracture treated by hip replacement(HA)were included in the experimental group and underwent TEG tests on the first day of admission(D1),the first postoperative day(D2),the third postoperative day(D3),the seventh postoperative day(D4),and the tenth postoperative day(D5),respectively.A correlation analysis was conducted on the statistical parameters obtained from the two groups.Patients in the experimental group underwent color Doppler ultrasound of the lower limb vein on the D5,and they were divided into DVT group and non-DVT group according to the ultrasound results.The receiver operating characteristic curve(ROC)was used to analyze the clinical efficacy of TEG in preventing DVT.Results The TEG parameters of the control group were all in the normal range.Compared with the control group,the coagulation reaction time(R),blood clotting time(K)on D1,D2,D3,D4 and D5 in the experimental group significantly decreased,while the coagulation angle(α),maximum amplitude(MA)and comprehensive coagulation index(CI)values increased,all with statistically significant differences(P<0.05);Compared with those on D2,R and K decreased,andαangle,MA and CI increased significantly on D3 and D4,all with statistically significant differences(P<0.05).Compared with those on D3 and D4,R and K increased,andαangle,MA,and CI decreased on D5,all with statistically significant differences(P<0.05).Compared with the non-DVT group,the R,K,andαangle,MA and CI were significantly different in the DVT group(P<0.05),and the ROC curve showed thatαangle,MA,and CI had a higher value in preventing the formation of DVT.Conclusion TEG can timely assess the coagulation function of patients with femoral neck fracture during the perioperative period,and provide beneficial help for reducing the risk of DVT.