老年全膝关节置换术72例低分子肝素配伍巴曲亭抗凝效果观察

目的:探讨老年重度膝关节骨性关节炎人工全膝关节置换术应用低分子肝素抗凝中加用巴曲亭的临床效果。方法:选择在我院进行人工全膝关节置换术治疗的137例重度膝关节骨性关节炎患者,随机分为治疗组(72例)和对照组(65例)。两组患者均在手术前预防性使用低分子肝素,治疗组在此基础上注射巴曲亭,对照组给予相同剂量的安慰剂。观察比较两组患者术中、术后引流量,凝血水平,下肢静脉血流情况。结果:治疗组患者术中、术后引流量平均为432.45±112.20ml,212.47±75.33ml,对照组患者术中、术后引流量平均为635.72±99.53ml,275.61±107.40ml,两组患者术中、术后引流量相比有显著性差异(P<0.05);术前、术毕及术后24h凝血水平:治疗组PT分别为11.14±0.75s,11.35±0.68s,11.27±0.82s;APTT分别为29.37±3.68s,30.57±4.42s,30.18±3.70s;Fbg分别为3.26±0.67g/L,3.29±0.74g/L,3.05±0.61g/L。对照组PT分别为11.14±0.75s,11.33±0.79s,11.54±0.72s;APTT分别为30.08±4.16s,30.47±4.55s,29.79±3.65s;Fbg分别为3.25±0.62g/L,3.14±0.73g/L,3.12±0.77g/L,两组患者术前、术毕及术后24h凝血水平相比无显著性差异(P>0.05);术后5d下肢深静脉彩色多普勒超声检查示:观察组有2例发生下肢深静脉血栓,对照组发生1例下肢深静脉血栓,其余患者的下肢深静脉回流速度和回流血量:治疗组术前、术后分别为6.38±2.19cm/s,3.77±2.12ml/s,6.09±1.87cm/s,3.56±1.58ml/s。对照组术前、术后分别为6.28±2.10cm/s,3.82±1.97ml/s,6.10±1.89cm/s,3.56±1.56ml/s。两组下肢深静脉回流速度和回流血量无显著性差异(P>0.05)。结论:术前应用巴曲亭能够明显减少应用低分子肝素抗凝的全膝关节置换术患者的出血量,且不会增加下肢静脉血栓的发生率。

A study of hemocoagulase application in total knee arthroplasty with low molecular heparin among elderly patients

Objective:To explore the clinical effect of application of low molecular heparin anticoagulation with hemocoagulase in total knee arthroplasty among elderly patients with severe knee osteoarthritis.Methods:To choose 137 cases of patients with severe keen osteoarthritis and have total total knee arthroplasty.They were randomly divided into observation group and control group,both with low molecular heparin for prevention before surgery.Observation group also receive hemocoagulase injection and control group receive the same dose of placebo.Observe and compare the situation of surgery and postoperative drainage,blood coagulation level and venous blood flow between two groups.Results:The average surgical and postoperative drainage volume of hemocoagulase group were 432.45±112.20ml and 212.47±75.33ml,while these number of control group were 635.72±99.53 ml and 275.61±107.40 ml,difference between two groups was significant(P<0.05);The PT record of hemocoagulase group before,during and after operation were 11.14±0.75s,11.35±0.68s,11.27±0.82s respectively.These number of APTT were 29.37±3.68s,30.57±4.42s,30.18±3.70s and Fbg were 3.26±0.67 g/L,3.29±0.74 g/L,3.05±0.61 g/L,respectively.PT of control group during these three period of time were 11.14±0.75s,11.33±0.79s,11.54±0.72s,APTT are 30.08±4.16s,30.47±4.55s,29.79±3.65s and Fbg were 3.25±0.62 g/L,3.14±0.73 g/L,3.12±0.77 g/L.Difference between the two groups was not significant(P>0.05);After 5 days,there were 2 patients who suffered from deep venous thrombosis at hemocoagulase group,while these number at control group was 1.The reflux speed(cm/s) and backflow of blood(ml/s) of other patients in two group before and after operation were 6.38±2.19s,3.77±2.12s,6.09±1.87s,3.56±1.58s and 6.28±2.10s,3.82±1.97s,6.10±1.89s,3.56±1.56s.These was no sigificant between these two groups.(P>0.05).Conclusion:The preoperative hemocoagulase application can significantly reduce the bleeding amount with low molecular heparin in total knee arthroplasty patients and will not increase the incidence of deep vein thrombosis,with clinical value to some extent.