低分子肝素钙在脊柱创伤患者椎弓根螺钉内固定术后的应用效果分析

Application Effect of Low Molecular Weight Heparin Calcium in Patients with Spinal Cord Traumas after Pedicle Screw Internal Fixation

目的 探讨低分子肝素钙在脊柱创伤患者椎弓根螺钉内固定术后的应用效果。方法 选取2019年3月至2021年3月铁岭市中心医院收治的84例脊柱创伤患者作为研究对象,按照随机数表法将其随机分为观察组(42例)和对照组(42例),对照组患者于椎弓根螺钉内固定术后予以常规治疗,观察组患者于椎弓根螺钉内固定术后在常规治疗的基础上予以低分子肝素钙注射,对比观察两组患者血液流变学指标、凝血功能指标与血清炎症因子水平以及不良反应发生情况。结果 术后3d,观察组患者全血高切黏度、中切黏度、低切黏度均明显低于对照组(t=23.136、26.260、39.423,P均<0.001),活化部分凝血活酶时间(APTT)明显长于对照组(t=2.715,P=0.008),凝血酶原时间(PT)明显短于对照组(t=5.471,P<0.001),血清白细胞介素(IL)-6、IL-10、C反应蛋白(CRP)水平均明显低于对照组(t=16.557、4.465、20.663,P均<0.001);治疗期间,观察组患者深静脉血栓形成发生率明显低于对照组(χ^(2)=4.487,P=0.034),而出血倾向发生率无明显差异(χ^(2)=1.383,P=0.240)。结论 脊柱创伤患者椎弓根螺钉内固定术后应用低分子肝素钙,可有效降低血液黏度,改善血液高凝状态,抑制炎症反应,预防深静脉血栓形成,且安全性较高。

Objective To study the application effect of low molecular weight heparin calcium in patients with spinal cord traumas after pedicle screw internal fixation.Methods 84 patients with spinal cord traumas admitted into Tieling Central Hospital between March 2019 and March 2021 were enrolled as research subjects,and then divided into study group(n=42) and control group(n=42) using the random number table.Patients in the control group were given the routine treatments after the pedicle screw internal fixation,while patients were injected low molecular weight heparin calcium based on the routine treatments after the pedicle screw internal fixation in the study group.The hemorheological indexes,coagulation function indexes,levels of serum inflammatory factors and the occurrence of adverse reactions of patients were compared between the two groups.Results Three days,after operation,compared with the control group,the whole blood high shear viscosity(t=23.136,P 0.001),middle shear viscosity(t=26.260,P 0.001) and low shear viscosity(t=39.423,P 0.001) of patients in the study group were all markedly lower,the activated partial thromboplastin time(APTT) was obviously longer(t=2.715,P=0.008),the prothrombin time(PT) was obviously lower(t=5.471,P 0.001),and levels of serum interleukin(IL)-6,IL-10 and serum C-reactive protein(CRP) were all markedly lower(t=16.557,4.465 and 20.663,all P 0.001).During the course of treatment,the incidence of deep venous thrombosis in the study group was obviously lower than that in the control group(χ~2=4.487,P=0.034),but there was no statistically significant difference between the two groups in terms of the occurrence of bleeding tendency(χ~2=1.383,P=0.240).Conclusion The postoperative application of low molecular weight heparin calcium in patients with spinal cord traumas can effectively decrease the blood viscosity,improve the hypercoagulable state of blood,inhibit inflammatoiy responses and prevent the formation of deep venous thrombosis.Moreover,it is safe to use.