基于血栓弹力图制定的干预措施在老年股骨颈骨折患者围术期的应用效果

Effect of perioperative intervention measures based on thromboelastogram for elderly patients with femoral neck fracture

目的探究基于血栓弹力图(TEG)制定的干预措施在老年股骨颈骨折患者围术期的应用效果。方法选择2020年8月至2021年8月宿迁市宿城区人民医院老年股骨颈骨折患者54例作为研究对象,采用随机数字表法对患者分组,每组27例。对照组男16例、女11例,年龄(73.14±2.58)岁;试验组男14例、女13例,年龄(73.15±2.64)岁。对照组给予常规围术期干预措施,试验组给予基于TEG制定的干预措施。比较两组患者术后发生血栓事件概率、凝血功能、TEG相关指标。统计学方法采用独立样本t检验、配对t检验、χ^(2)检验。结果试验组患者术后血栓事件的总发生率为0,明显低于对照组的22.22%(6/27),差异有统计学意义(χ^(2)=4.687,P=0.030)。干预前,两组患者凝血功能相关指标D-二聚体(D-D)、纤维蛋白原(Fib)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)比较差异均无统计学意义(均P>0.05);干预后两组患者的D-D、Fib水平降低,PT、APTT时间延长,差异均有统计学意义(均P<0.05);试验组的D-D、Fib水平低于对照组,PT、APTT时间比对照组长,差异均有统计学意义(均P<0.05)。干预前,两组患者的TEG指标[反应时间(R)、凝血时间(K)、最大振幅(MA)、α角]比较差异均无统计学意义(均P>0.05);干预后两组患者的TEG指标均优于干预前(均P<0.05),且试验组均优于对照组(均P<0.001)。结论老年股骨颈骨折患者围术期应用基于TEG制定的干预措施具有良好的应用效果,可改善患者的血液高凝状态,预防静脉血栓,提高生活质量。

Objective To explore the effect of perioperative intervention measures based on thromboelastogram(TEG)for elderly patients with femoral neck fracture.Methods Fifty-four elderly patients with femoral neck fracture treated at Sucheng District People's Hospital from August 2020 to August 2021 were selected as the research objects.The patients were divided into a control group and an experimental group by the random number table method,with 27 cases in each group.The control group had 6 males and 11 females,and they were(73.14±2.58)years old.The experimental group had 14 males and 13 females,and they were(73.15±2.64)years old.The control group were given routine perioperative intervention measures,and the experimental group perioperative intervention measures based on TEG.The probabilities of postoperative thrombotic events,coagulation function,and TEG related indicators were compared between the two groups.The independent-sample t,paired t,andχ^(2) tests were applied.Results The probability of postoperative thrombotic events was 0 in the experimental group,and was 22.22%(6/27)in the control group,with a statistical difference(χ^(2)=4.687,P=0.030).Before the intervention,there were no statistical differences in D-dimer(D-D),fibrinogen(Fib),prothrombin time(PT),and activated partial thromboplastin time(APTT)between the two groups(all P>0.05).After the intervention,the levels of D-dimer and Fib decreased and the PT and APTT prolonged in both groups,with statistical differences(all P<0.05).The levels of D-D and Fib were lower and the PT and APTT were longer in the experimental group than in the control group,with statistical differences(all P<0.05).There were no statistical differences in the TEG indicators[reaction time(R),clotting time(K),maximum amplitude(MA),andαangle]between the two groups(all P>0.05).After the intervention,the TEG indicators were better than those before the intervention(all P<0.05),and were better in the experimental group than in the control group(all P<0.05).Conclusion Perioperative intervention measures based on thromboelastogram for elderly patients with femoral neck fracture is effective and can improve their blood hypercoagulability and quality of life and prevent venous thrombosis.