髋关节置换手术患者的抗凝应用时间研究

Study on anticoagulant application time of patients with hip replacement operation

目的 :研究髋关节置换手术患者的抗凝应用时间。方法 :选取在我院进行全髋关节置换的股骨头坏死患者100例,随机分为A、B两组,每组各50例,两组患者在手术后6-8h开始,皮下注射低分子肝素钠5000IU、每天1次,A组服用疗程为10d,B组服用疗程为30d。在全髋关节置换术(THA)前1d与术后第1、10、30d分别抽取A、B两组患者的静脉血样,进行凝血酶-抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段F1+2(F1+2)、D-二聚体(D-dimer)与血浆纤维蛋白原(Fib)等指标的检测。同时,对患者下肢进行静脉造影检查。最后,对检测结果进行比较分析。结果 :相对A组,B组患者在术前1d、术后第10d TAT、F1+2、D-dimer与Fib等指标均无显著差异;相对术前1d,A、B两组患者在术后第10d凝血四项指标均显著升高,差异具有统计学意义。相对A组,B组患者在术后第30d TAT、F1+2、D-dimer等指标显著降低,差异具有统计学意义;相对术前1d,两组患者在术后第30d TAT、F1+2、D-dimer等指标均显著升高,差异具有统计学意义,两组患者术后30d Fib升高不明显;A、B两组患者均有2例出现血栓现象。结论 :髋关节置换术后患者体内的凝血机制能被早期激活,之后的高凝状态可持续30d。尽管延长使用抗凝药物不能够彻底消除患者血液的高凝状态,可是能够在一定程度上起到缓解作用。

Objective To study the anticoagulant application time of patients with hip replacement operation. Methods 100 patients with osteonecrosis of the femoral head , total hip replacement in our hospital patients, 100 patients were randomly divided into A, B two groups,100 cases in each group, A, B two groups of patients in 6-8h after operation, daily subcutane-ous injection low-molecular-weight heparin 0.4 ml, group A received treatment for 10 days, group B received treatment for 30 days. In THA 1 day before and after 1, 10, 30 day respectively A, B venous blood samples from two groups of patients, of TAT,F1+2,D-dimer and Fib detection index. At the same time, intravenous contrast examination in patients with lower extrem-ity. Finally, on a comparative analysis of test. Results Compared with A group, B group patients in the preoperative 1d, section 10d, TAT, F1+2, D-dimer and Fib were not significantly different index; relative preoperative 1d, A, B two groups of patients were significantly increased in 10d after the first four items of blood coagulation index. Relative to the A group, patients in B group after 30d TAT, F1+2, D-dimer were significantly decreased, the difference was statistically significant; relative preop-erative 1d, A, B two groups of patients in operation after 30d of TAT, F1+2, D-dimer were significantly increased statistically significant. The preoperative 1d, A, B two groups of patients after 30d Fib did not increased significantly; after 30d, A, B two groups of Fib had no significant difference. A, B group two patients had two case of thrombosis phenomenon. Conclusion Af-ter total hip arthroplasty in patients with coagulation mechanism can be early activation, sustainable 30d hypercoagulable state after. Despite prolonged anticoagulant drugs can not completely eliminate blood hypercoagulability of patients, but can rise to alleviate the effect to a certain extent.