Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Clinical Value of Predictive Nursing Intervention on Deep Venous Thrombosis of Lower Extremities after Cesarean Section

[Objectives]To explore the clinical nursing value of predictive nursing intervention in patients with deep venous thrombosis of lower extremities after cesarean section.[Methods]From December 2022 to April 2023,105 pregnant and lying-in women who were hospitalized in the Gynecology Department of Pingquan Hospital and underwent cesarean section and met the inclusion criteria were included as the study objects.According to the medical records,they were divided into observation group(n=52 cases)and control group(n=53 cases).The clinical experimental subjects were divided into two groups.One group was the control group with routine nursing,and the other group was the observation group with predictive nursing intervention.The number of cases of deep venous thrombosis of lower extremities in the two groups was recorded to evaluate the clinical value.[Results]The incidence of deep venous thrombosis of lower extremities in the two groups after cesarean section was compared,and it was suggested that the incidence of the observation group was lower than that of the control group(P<0.05).[Conclusions]Special predictive nursing intervention can greatly reduce the incidence of deep venous thrombosis of lower extremities after cesarean section,improve nursing satisfaction,and improve clinical efficacy,which is worthy of recommendation.

Deep Venous Thrombosis: Commonly Affected Veins in the Lower Limbs

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

Comparison of four clinical scores for the predicting lower limb deep venous thrombosis in Chinese patients

Objective：To evaluate Wells, Kahn, St.Andr 6 and Constans scores for the prediction of deep venous thrombosis in Chinese patients. Methods：One hundred and seventy-two patients, prospectively, blinded referred for evaluation with four clinical-score systems for suspected deep venous thrombosis, were examined by ultrasonography. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operation curves were calculated for four clinical scores. The difference between areas of the ROC curve for each of the scores was compared with others and reference line. Results：Forty-six of 172 patients had deep venous thrombosis proven by sonography. The sensitivity, specificity, positive predictive value and negative predictive value for Wells score was 91.3%, 57.1%, 43.8% and 94.7%, respectively, for Kahn score; 65.2%, 71.4%, 45.5% and 84.9%, respectively, for St.Andr 6 score; 63%, 38.9%, 27.4% and 74.2% respectively, for Constans score; 95.7%, 34.9%, 34.9% and 95.7% respectively. Area under ROV curve of Constans score was 0.814, which was similar to that of Wells score, then followed by Kahn score and that of St.Andr 6 score was no difference with the reference line. Conclusion：Based on the results of our study, the sensitivity, negative prediction value and area under ROC curve are larger for Constans score and Wells score in Chinese hospitalized patients than that of Kahn score or St.Andr 6 score. Considering the aim of the clinical assessment, Constans score and Wells score are more efficient for Chinese hospitalized patients.

Combined effect of Traditional Chinese Medicine decoction and low-molecular-weight heparin calcium on the postoperative deep venous thrombosis in patients with lower limb fracture

OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fracture.METHODS: Totally 86 hospitalized patients with DVT after surgery of lower limb fracture between September 2012 and January 2015 were recruited and randomly divided into control group and observation group, 43 cases in each group. The patients in the control group were treated with subcutaneous injection of low-molecular-weight heparin calcium, and those in the observation group were additionally given Danshen Injection and TCM decoction. The differences between two groups in occurrence rate, medication time, therapeutic effects,recurrence rate of thrombosis, activated partial thromboplastin time(APTT), and prothrombin time(PT) were compared.RESULTS: The occurrence rate of DVT in observation group(4.65%, 2/43) was lower than that in control group(27.91%,12/43)(P<0.05). The medication time of observation group was(6.15±2.94) d, shorter than(9.76±3.12) d in the control group(P<0.05). In observation group, 2 cases of DVT were cured(2/2); in the control group, 9 cases presented therapeutic effects and the total effective rate was 75.00%(9/12). The improvement of APTT and PT in the observation group was better than that in the control group(P<0.05).CONCLUSION: Integrative TCM decoction plus low-molecularweight heparin calcium is superior to applicaton of low-molecularweight heparin calcium alone in reducing and treating DVT in the postoperative patients with lower limb fracture.

Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?

BACKGROUND: Deep venous thrombosis(DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department(ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with DVT.METHODS: This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital's electronic medical record.RESULTS: A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379(15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated DVT.CONCLUSIONS: Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Discussion on Prevention and Treatment of Lower Extremity Deep Venous Thrombosis in Orthopedic Perioperative Period from Spleen and Stomach Meridians

Deep venous thrombosis of lower extremity is one of the common complications in orthopedic perioperative period.It is caused by many factors,such as peripheral vein dilation,slow blood flow;long-term immobilization,bed rest and so on.On the one hand,it affects the early postoperative functional exercise and functional recovery,on the other hand,it increases the length of hospital stay and economic burden,increases the pain of patients and even endangers their lives.Effective treatment of traditional Chinese medicine combined with western medicine can play a better role in the prevention and treatment of lower extremity deep venous thrombosis.This study expounds the concept of spleen and stomach meridians in the prevention and treatment of lower extremity deep venous thrombosis,and puts forward some opinions on the dialectical treatment and daily conditioning of lower extremity deep venous thrombosis,hoping to provide ideas for the clinical prevention and treatment of lower extremity deep venous thrombosis in traditional Chinese medicine.

Analysis of curative effect of Bingxiao powder on lower limb deep vein thrombosis

Objective:To investigate the therapeutic effect of Bingxiao powder on edema caused by deep venous thrombosis in lower limb thrombosis.Methods:Selected in our hospital from September 2017 to April 2019 of 122 patients with lower limb deep vein thrombosis caused by edema.The patients were divided into two groups:Bingxio powder(61 cases)and magnesium sulfate(61 cases),the circumference difference of lower leg and thigh,the integral of edema and pain,the effective rate and the satisfaction rate of curative effect were compared between the two groups of patients with edema caused by thrombosis of lower limb.Results:in the observation group,the peripheral diameter difference of calf(1.08±0.21)cm,the peripheral diameter difference of thigh(1.76±0.28),the edema score(1.09±0.22)and the pain score(1.34±0.25)were all lower than those of the control group(P<0.05).The effective rate(95.08%)and satisfaction rate(96.72%)of the observation group were higher than those of the control group(P<0.05).Conclusion:Bingxiao powder can reduce the edema symptoms and pain symptoms of patients with edema caused by deep venous thrombosis of lower limbs,and reduce the circumference difference of the lower leg and thigh,with significant clinical effect.

Prevention and Treatment of Deep Vein Thrombosis of the Lower Limbs in Patients with Complications after Orthopedic Trauma Surgery

Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years,and a total of 58 patients were selected.The patients were randomly divided into two groups,with 29 patients in the control group treated with conventional clinical methods;and the other 29 patients were assigned to the experimental group,where targeted preventive and therapeutic measures were administered.During the research,the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients.Results:According to the results of clinical experiments,the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group(P<0.05);in addition,when complications of deep venous thrombosis of the lower limbs occurred,the treatment efficacy of the patients in the experimental group was 96.55%,and the treatment efficacy of the patients in the control group was 82.76%.There was a significant difference between the two groups(P<0.05).Conclusion:Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery,this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

椎管内麻醉与全身麻醉下手术的下肢骨折老年患者LDVT发生率比较

目的:比较椎管内麻醉与全身麻醉下手术对下肢骨折老年患者下肢深静脉血栓(LDVT)发生率的影响。方法:选取2020年1月至2022年1月在永城市人民医院接受手术治疗的90例下肢骨折老年患者,依据随机数字表将全部患者均分为对照组(全身麻醉)与观察组(椎管内麻醉),各45例。比较两组患者手术情况、术后恢复情况、麻醉情况、术中生命体征、术后48 h运动功能状态,统计术后LDVT与麻醉并发症发生率。结果:观察组患者手术时间、术中出血量、术后床旁活动时间及住院时间均少于对照组,差异具有统计学意义(P<0.05);观察组患者麻醉生效时间、术后睁眼时间、语言陈述恢复时间、术中麻醉药物用量均少于对照组,差异具有统计学意义(P<0.05);观察组患者麻醉后10 min(T1)、术毕即刻(T2)时心率、平均动脉压均低于对照组,差异具有统计学意义(P<0.05);观察组患者术后48 h的运动功能分级优于对照组,差异具有统计学意义(Z=2.183,P<0.05);观察组患者术后LDVT发生率与麻醉不良反应总发生率均低于对照组,差异具有统计学意义(P<0.05)。结论:椎管内麻醉与全身麻醉相比,能够有效降低下肢骨折老年患者术后LDVT发生风险。

血浆D-D、凝血因子、PC变化与乳腺癌根治术后发生DVT的多因素研究

目的探讨血浆D-二聚体(D-D)、凝血因子、血浆蛋白C(PC)与乳腺癌根治术后发生下肢深静脉血栓(DVT)的关系。方法选取接受乳腺癌根治术治疗且术后发生DVT的患者45例作为病例组,同期接受乳腺癌根治术未发生DVT的患者90例作为对照组;统计并分析两组的年龄、体质量指数(BMI)、乳腺癌病理学类型、肿瘤淋巴结转移分期(TNM)、辅助化疗、合并疾病情况、红细胞(RBC)、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、D-D、凝血因子Ⅷ(FⅧ)、血浆PC的水平,并采用向前Logistic回归分析法分析D-D、FⅧ、血浆PC与乳腺癌根治术后发生DVT的关系。结果两组年龄、体质量指数(BMI)、患侧分布、病理学类型、TNM分期、高血压、糖尿病、RBC、TT水平比较,差异无统计学意义(P>0.05),病例组的辅助性化疗患者占比、FIB水平均高于对照组,PT、APTT水平均低于对照组(P<0.05);病例组D-D、FⅧ水平高于对照组(P<0.05);病例组血浆PC水平低于对照组(P<0.05);Logistic回归模型结果显示FIB增高、D-D升高、FⅧ水平升高及APTT水平降低是乳腺癌根治术术后发生DVT的独立危险因素(OR=1.602,2.042,2.134,1.430,P<0.05)。结论引起乳腺癌术后发生DVT的因素众多,D-D、FⅧ水平升高会显著的增高乳腺癌根治术后发生DVT的风险。

置管溶栓术结合支架植入对急性下肢DVT患者血流畅通和血栓后综合征的影响

目的探讨置管溶栓术结合支架植入对急性下肢深静脉血栓(DVT)患者血流畅通和血栓后综合征的影响。方法选取104例急性下肢DVT患者,随机均分为联合组(置管溶栓术+支架置入)和溶栓组(置管溶栓术)。比较两组治疗前后静脉畅通率、下肢周径差、血液流变学指标,以及血栓后综合征(PTS)、并发症情况。结果联合组静脉畅通率高于溶栓组(P<0.05)。与治疗前比较,治疗后两组双侧大腿周径差、双侧小腿周径差随治疗时间延长逐渐下降,且联合组变化更为显著(P<0.05)。与治疗前比较,两组治疗后血液流变学指标均降低(P<0.05),但两组间比较差异无显著性(P>0.05)。随访2年,联合组发生PTS程度低于溶栓组(P<0.05)。治疗时两组并发症发生率比较差异无显著性(P>0.05)。结论置管溶栓术结合支架置入能更有效地再通急性下肢DVT患者静脉,降低PTS发生。

CDT联合支架置入与系统溶栓治疗IVCS合并下肢DVT的效果及安全性对比

目的:探究并对比导管接触性溶栓(CDT)联合支架置入与系统溶栓治疗髂静脉受压综合征(IVCS)合并下肢深静脉血栓(DVT)的效果及安全性。方法:选取新余市人民医院2020年6月—2022年6月收治的70例IVCS合并下肢DVT患者作为研究对象,采用随机数字表法分为非手术组和手术组,各35例。非手术组患者给予系统溶栓治疗,手术组患者给予CDT联合支架置入治疗。观察并比较两组患者凝血指标[D-二聚体(D-D)、组织型纤溶酶原激活物(t-PA)、凝血酶原时间(PT)];静脉阻塞情况(阻塞评分、溶栓率、静脉通畅率);水肿情况(患肢围径差、消肿率);治疗期间住院情况(住院天数、住院费用);预后效果[继发性下肢深静脉瓣膜功能不全、下肢深静脉血栓后遗症(PTS)]。结果:治疗5 d后,手术组患者D-D水平低于非手术组,t-PA水平高于非手术组,PT长于非手术组(P<0.05)。治疗3个月后,手术组患者阻塞评分低于非手术组(P<0.05);手术组患者溶栓率、静脉通畅率均高于非手术组(P<0.05)。治疗3个月后,手术组患者膝上、膝下腿围径差均小于非手术组(P<0.05);手术组患者膝上、膝下消肿率均高于非手术组(P<0.05)。手术组患者住院天数少于非手术组(P<0.05)。手术组患者继发性下肢深静脉瓣膜功能不全发生率及PTS发生率均低于非手术组(P<0.05)。结论:CDT联合支架置入治疗用于IVCS合并下肢DVT患者可改善其临床症状,治疗效果较常规系统溶栓治疗更佳,且治疗后恢复更快,预后更为理想。

低分子肝素联合温针灸及穴位贴敷治疗预防下肢骨折患者术后DVT形成的临床研究

目的:研究低分子肝素(LMWH)联合温针灸及穴位贴敷对于下肢骨折患者术后深静脉血栓(DVT)的预防效果。方法:选取2021年4月—2023年3月上海沪东医院收治的70例行下肢骨折手术的患者作为研究对象,按照随机数表法分为对照组与试验组,每组各35例,分别采用LMWH皮下注射治疗与此基础上加用温针灸及穴位贴敷,观察两组术后DVT发生情况、手术前后血栓弹力图(IEG)及相关血液指标检测结果。结果:两组术后DVT发生率,差异无统计学意义(P>0.05);TEG检测中试验组术后7 d时凝血指数、血块动力及血块强度均显著低于对照组,血液凝固时间显著高于对照组,差异有统计学意义(P<0.05);D-二聚体(D-D)及血小板计数(PLT)显著低于对照组,差异有统计学意义(P<0.05)。结论:对下肢骨折手术患者采用LMWH联合温针灸及穴位贴敷进行预防性治疗,能够改善患者下肢血液循环,有效降低DVT发生风险,且未见不良反应发生。

外周血t-PAIC、PIC结合超声弹性成像技术在下肢DVT评估中的应用价值

目的:探讨外周血组织型纤溶酶原激活物/纤溶酶原激活物抑制剂-1复合物(t-PAIC)、纤溶酶-α_(2)纤溶酶抑制物复合物(PIC)结合超声弹性成像技术在下肢深静脉血栓(DVT)评估中的应用价值。方法:选取206名疑似下肢DVT患者为研究对象,将临床确诊为下肢DVT的患者纳入DVT组(n=41),非下肢DVT患者纳入非DVT组(n=165);DVT组患者再根据分期分为急性期组(n=14)、亚急性期组(n=16)和慢性期组(n=11)。比较DVT组和非DVT组、DVT组中不同分期患者外周血指标(t-PAIC及PIC水平)、超声弹性成像参数(超声弹性成像评分及应变值)、Caprini血栓风险评分水平差异;采用Pearson相关性分析其与下肢DVT分期的相关性;ROC曲线评估其对下肢DVT的诊断价值。结果:DVT组患者t-PAIC及PIC水平、超声弹性成像评分及应变值、Caprini血栓风险评分均高于非DVT组(P<0.05)。DVT组中不同分期患者外周血t-PAIC及PIC水平、超声弹性成像评分及应变值、Caprini血栓风险评分比较,差异均有统计学意义(P<0.05),且急性期<亚急性期<慢性期。相关性分析显示,t-PAIC及PIC水平、超声弹性成像评分及应变值、Caprini血栓风险评分与下肢DVT分期均呈正相关关系(r=0.654、0.812、0.514、0.711、0.681,P<0.05)。ROC曲线分析显示,外周血t-PAIC及PIC水平、超声弹性成像评分及应变值、Caprini血栓风险评分及联合检测下肢DVT的曲线下面积(AUC)分别为0.754,0.765,0.759,0.730,0.752和0.894,联合检测诊断价值更高(P<0.05)。结论:外周血t-PAIC、PIC水平联合超声弹性成像技术对下肢DVT有较好的诊断价值,且有利于疾病分期。

超声血流参数、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢DVT预警中的应用价值

目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,根据术后是否发生下肢DVT分为发生组25例与未发生组175例。收集2组基线资料及手术前后Vs、Vd、RI、D-二聚体数据,根据创伤骨折患者术后下肢DVT发生影响因素构建预测复合模型,评估Vs、Vd、RI、D-二聚体手术前后差值联合及复合模型对创伤骨折患者术后下肢DVT发生的预测价值。绘制决策曲线分析(DCA),分析超声血流参数、D-二聚体与复合模型预测创伤骨折患者术后下肢DVT发生的获益情况。结果发生组手术时间长于未发生组,术中使用止血带比例高于未发生组(P<0.01);发生组术后3 d Vs、Vd低于未发生组,RI、D-二聚体高于未发生组(P<0.01);发生组Vs、Vd、RI及D-二聚体手术前后差值均大于未发生组(P<0.01);多因素Logistic回归分析显示,手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素(P<0.01);以Vs、Vd、RI、D-二聚体手术前后差值联合预测下肢DVT的曲线下面积(AUC)为0.882(95%CI:0.829,0.923),敏感度、特异度均为0.88。构建下肢DVT预测模型,其AUC为0.920(95%CI:0.873,0.954);DCA显示,复合模型在阈值概率为0.10~0.90时具有更高的临床价值。结论手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素;与Vs、Vd、RI、D-二聚体手术前后差值相比,多指标联合建立的复合模型在创伤骨折术后下肢DVT早期预警中应用价值更高。

血栓弹力图和凝血实验对指导创伤骨折手术后DVT发生的价值

目的:明确血栓弹力图和凝血试验指导对预防创伤骨折手术术后DVT的应用价值。方法:根据临床检测结果将80例发生创伤骨折患者分为观察组(DVT组,n=41)与39例对照组(非DVT组,n=39),评估术前血栓弹力图与凝血指标对创伤性骨折术后DVT的预测效能。结果:对照组手术时间、术中出血量、切口大小分别为(85.34±12.33)min、(113.53±25.79)ml、(5.34±1.54)cm,手术相关指标改善情况较观察组更好;对照组骨折愈合时间为(11.18±1.37)d,较观察组(15.26±1.75)d更短(t=11.571,P=0.001);对照组凝血功能指标优于观察组(P<0.05);T2时间段内,观察组血液凝固时间(K)、凝血反应时间(R)、凝固角(α)及最大振幅(MA)均较对照组更高(P<0.05),观察组患者处在高凝状态;术后K、α角、MA、PT、TT及PLT的AUG在0.7~1.0间,预测价值较高。结论:血栓弹力图中的K、α角、MA三项参数与凝血实验中PT、TT、PLT能有效筛查创伤骨折患者中术后发生DVT的高危人群。

利伐沙班对股骨转子间骨折患者术后凝血功能及DVT形成的影响

目的:探讨利伐沙班与低分子肝素对股骨转子间骨折(IFF)患者术后凝血功能及下肢深静脉血栓(DVT)的影响。方法:按照随机数字表法将2021年2月—2023年2月在本院接受治疗的72例IFF患者分为两组,各36例。对照组采用低分子肝素治疗[分别于入院至术前12 h、术后6 h采用低分子肝素钙皮下注射,4 100 IU/次],观察组采用利伐沙班治疗[于入院至术前12 h口服利伐沙班,10 mg/次,1次/d,并于术后2~12 h继续口服用药,10 mg/次,1次/d],两组均持续治疗至出院。比较两组凝血功能、DVT形成率、感染情况、术后康复情况、出血性事件以及不良反应。结果:治疗前两组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)和D-二聚体(D-D)水平比较无统计学差异(P>0.05);治疗后两组APTT和PT较治疗前明显增长,FIB水平明显增高,D-D水平明显降低,且观察组均优于对照组(P<0.05)。相比于对照组,观察组DVT形成率较低(P<0.05)。治疗前两组白细胞计数(WBC)、白细胞介素-6(IL-6)、C反应蛋白(CRP)和降钙素原(PCT)水平比较无统计学差异(P>0.05);治疗后两组WBC、IL-6、PCT和IL-6水平较治疗前降低(P<0.05);治疗后,观察组WBC和IL-6与对照组比较无统计学差异(P>0.05),观察组PCT和IL-6水平低于对照组(P<0.05)。两组出血性事件总发生率比较无统计学差异(P>0.05)。两组不良反应总发生率比较无统计学差异(P>0.05)。结论:利伐沙班与低分子肝素在IFF患者术后治疗中效果确切,二者均具有较高的安全性,但利伐沙班的整体疗效优于低分子肝素,在改善患者凝血功能、降低患者感染指标、减少DVT形成率等方面作用更为突出,值得推广。