摘要
目的 探讨术前应用低分子肝素（LMWH）预防老年人工髋关节置换术后下肢深静脉血栓（DVT）的有效性和安全性.方法 全麻下行人工髋关节置换术患者50例,年龄〉65岁,随机分为治疗组（T组）和对照组（C组）,每组25例.治疗组：术前2天,每天下午4点于患者腹部皮下注射LMWH 5 000 U;术后每天注射1次,剂量同术前,术后治疗7天.对照组术前、术后均不应用LMWH.2组术后处理相同.记录治疗组使用LMWH的并发症,评价安全性;比较2组DVT的发生率.结果 2组患者术中出血量、手术时间、血红蛋白（Hb）、纤维蛋白原（FIB）间差异无统计学意义（P〉0.05）.2组血小板（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、D-2聚体（DD）之间差异有统计学意义.C组术后第1天及第3天PLT高于T组（P〈0.05）,C组PT术后第1天及第3天低于T组（P〈0.05）,C组术后第3天APTT低于T组（P〈0.05）,C组术后第1天及第3天DD水平高于T组（P〈0.05）.2组患者术后下肢DVT发生率差异有统计学意义,C组高于T组（P〈0.05）.结论 LMWH术前应用可以预防髋关节置换术后DVT的发生,对于已发生的DVT有良好的治疗效果,不良反应发生率低.
Objective To explore the efficacy and safety of preoperative application of low molecular weight hepariu （LMWH） for the prevention of deep vein thrombosis （DVT） after total hip replacement in elderly patients. Methods Fifty patients aged 〉 65 years with tatal hip replacement were randomly divided into 2 groups ： treatment and control group, 25 patients in each group. The treatment group, preoperative 2 d, once a day, at 4 pm in patients with abdominal subcutaneous injection of LMWH 5 000 U ; Operation after a single daily injection, the dose with preoperative, were trea- ted for 7 d. The control group preoperative not use any prevention methods,postoperaive treatment with treatment group. Record treatment group using LMWH complications, evaluation of safety ; compared with the incidence rate of DVT. Re- suits Two groups of patients, operation time, bleeding volume, fibrinogen and hemoglobin without statistical signifi- cance （ P 〉 0.05 ） . Two groups of platelet, prothrombin time, activated partial thromboplastin time, D - 2 dimer was statistically significant difference between. The control group after first days and 3 days of platelet is higher than the treat- ment group （ P 〈 0.05 ） ; prothrombin time lower than the treatment group （ P 〈 0.05 ） ; the control group after 3 days of activated partial thromboplastin time lower than the the treatment group （ P 〈 0.05 ）, the control group after first days and 3 days of DD levels is higher than the treatment group （ P 〈 0.05 ）. Two groups of patients with lower extremity DVT inci- dence differences have statistical significance, the control group was higher than that of the treatment group （ P 〈 0.05 ）. Conclusion Preoperative application of LMWH can prevent the occurrence of DVT after total hip replacement, at the same time for the DVT already happened has good curative effect and adverse reaction rate is low.
出处
《徐州医学院学报》
CAS
2012年第3期158-161,共4页
Acta Academiae Medicinae Xuzhou
基金
江苏省自然科学基金 （BK2009090）
关键词
低分子肝素
髋关节置换
深静脉血栓
预防
low molecular weight heparin
hip replacement
deep vein thrombosis
prevention
