低分子肝素预防老年髋关节周围骨折术后下肢深静脉血栓的研究

目的探讨低分子肝素预防髋关节周围骨折术后下肢深静脉血栓(DVT)发生的有效性和安全性。方法选取年龄大于60岁的髋关节周围骨折患者76例随机分为2组:对照组40例行物理方法预防;实验组36例行物理方法预防+低分子肝素预防。分别于入院时,术后1 d1、0 d查血常规、凝血四项;于入院时,术后10 d、1个月、3个月行下肢静脉彩超检查了解有无下肢DVT,记录术后引流量,2组进行比较。结果对照组术后10例发生DVT,发生率25%,实验组术后2例发生DVT,发生率6%,2组比较有显著性差异(P<0.05)。选取病例数较多的股骨头置换术患者进行术后引流量比较,无显著性差异(P>0.05),且无一例出现出血并发症。2组患者血红蛋白、血小板、凝血酶原时间及活化部分凝血活酶时间变化比较均无显著性差异(P均>0.05)。结论应用低分子肝素能有效地预防髋部骨折患者术后DVT的发生;对血小板、血红蛋白、凝血机制无影响,未明显增加术后引流量。

Study of low molecular heparin preventing beforehand postoperative deep vein thrombosis in elderly patients with hip joint periphery fracture

Objective It is to approach the efficacy and safety of low molecular Heparin(LMWH) preventing beforehand postoperative deep venous thrombosis(DVT) of lower limbs in elderly patients with hip joint periphery fracture.Methods 76 patients with hip joint periphery fracture whose ages were more than 60 years were selected and randomly divided into two groups.40 cases were in control group and used physical method to prevent beforehand.The other 36 cases were in experimental group and used physical method and LMWH to prevent beforehand.The blood routine examination and four test items of blood coagulation were determined respectively on admission and postoperative one day and ten days.The lower limb color ultrasonography was used to examine and observe DVT of lower limbs on admission and postoperative ten days,one month and three months respectively.The postoperative draining volume of the two groups were recorded and compared.Results Ten patients in control group presented postoperative DVT and the rate was 25%.Two patients in experimental group presented postoperative DVT and the rate was 6%.There was significant difference between the two groups(P<0.05).There was no significant difference on postoperative draining volume among femoral head prosthetic replacement patients whose cases were more in the two groups(P>0.05) and none bleeding complications.There was no significant difference on the changes of hemoglobin,platelet,prothrombin time and activated partial thromboplastin time between the two groups(P>0.05).Conclusion LMWH can effectively prevent beforehand postoperative DVT in hip fracture patients,has no influence on platelet,hemoglobin and clotting mechanisms and can not obviously increase postoperative draining volume.