早期持续被动活动联合低分子肝素钠对髋关节置换患者术后凝血功能及深静脉血栓形成发生率的影响

Effect of early sustained passive activity combined with low molecular heparin sodium on postoperative coagulation and incidence of DVT in hip arthroplasty patients

目的:探讨早期持续被动活动联合低分子肝素钠对髋关节置换患者术后凝血功能及深静脉血栓形成(Deep venous thrombosis,DVT)发生率的影响。方法:回顾性分析我院2021年2月—2022年10月收治的79例髋关节置换术患者临床资料。根据患者术后不同治疗方案分为普通肝素钠联合组(32例,早期持续被动活动联合普通肝素钠治疗)与低分子肝素钠联合组(47例,早期持续被动活动联合低分子肝素钠治疗)。比较2组术后凝血功能指标、血液流变学指标、DVT发生率及不良反应发生情况。结果:治疗7 d后,低分子肝素钠联合组活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)高于普通肝素钠联合组,纤维蛋白原(Fibrinogen,FIB)、D-二聚体(D-dimer,D-D)、血浆黏度、全血高切黏度、全血低切黏度均低于普通肝素钠联合组,差异均有统计学意义(P<0.05);低分子肝素钠联合组DVT发生率、牙龈出血、皮下瘀斑发生率均低于普通肝素钠联合组,差异均有统计学意义(P<0.05);2组血小板减少、鼻出血发生率比较,差异无统计学意义(P>0.05)。结论:髋关节置换术后采用早期持续被动活动联合低分子肝素钠治疗可帮助患者改善凝血功能与血液流变学,降低DVT发生率,减少不良反应的发生。

Objective:To investigate the effect of early sustained passive activity combined with low molecular heparin sodium on postoperative coagulation and incidence of deep vein thrombosis(DVT)in hip replacement patients.Methods:Retrospective clinical data of 79 hip arthroplasty patients admitted to our hospital from February 2021 to October 2022 was made.The patients were divided into common heparin sodium combined group(32 cases,early sustained passive activity combined with ordinary heparin treatment)and low molecular weight heparin sodium combined group(47 cases,early sustained passive activity combined with low molecular heparin sodium treatment)according to their different postoperative treatment regimens.Comparison of postoperative coagulation indexes,blood rheology indexes,DVT incidence and adverse reactions between the two groups was made.Results:After 7 days of treatment,low molecular weight heparin sodium combined group had higher APTT and PT,and lower FIB,D-D,plasma viscosity,whole blood high cut viscosity,and whole blood low cut viscosity than those in common heparin sodium combined group(P<0.05).The incidence of DVT,gingival bleeding and subcutaneous ecchymosis in low molecular weight heparin sodium combined group were lower than that in common heparin sodium combined group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of thrombocytopenia and nosebleed between groups(P>0.05).Conclusion:Treatment with early sustained passive activity combined with low molecular heparin sodium after hip arthroplasty can help patients improve coagulation and blood rheology,reduce the incidence of DVT,and decrease the incidence of adverse reactions.