综合防治法预防老年人股骨近端骨折下肢深静脉血栓形成的比较研究

目的 探讨对老年人股骨近端骨折围手术期下肢深静脉血栓（deep venous thrombosis，DVT）形成的预防策略。方法对2003年7月-2006年5月收治的65岁以上符合筛选条件的157例股骨近端骨折患者进行对照研究。综合防治组82例，男34例，女48例；年龄65～97岁。股骨颈骨折30例，股骨粗隆间骨折52例。对照组75例，男33例，女42例；年龄65～94岁。股骨颈骨折28例，股骨粗隆间骨折47例。两组二维彩色超声多普勒（color doppler flow imaging，CDFI）检查，均无DVT形成。患者均牵引后行相应手术治疗，对照组不进行抗凝处理；综合防治组给予口服阿司匹林、纤溶酶静脉滴注、踝关节“环转”运动、CPM机等组成的综合防治。术后7、14d行下肢CDFI检查进行比较。结果综合防治组术后7、14d下肢CDFI检查示各有2例DvT形成，中央型3例，周围型1例，DVT发生率为4．9％；1例术后3d出现黑便，停用阿司匹林及纤溶酶对症治疗后好转。对照组术后7、14d下肢CDFI检查示分别有21例和15例DVT形成，中央型21例，周围型6例，混合型9例，DVT发生率为48．0％；其中2例分别于术后8、11d猝死，尸检证实为急性肺栓塞。两组DVT发生率比较差异有统计学意义（P〈0．01）。结论 围手术期综合防治对于预防老年人股骨近端骨折围手术期DVT发生具有积极的临床意义。

COMPREHENSIVE PROPHYLAXIS FOR DEEP VENOUS THROMBOSIS AFTER PROXIMAL FEMUR FRACTURES IN GERIATRIC PATIENTS

OBJECTIVE: To evaluate the efficacy and safety of comprehensive prophylaxis for deep venous thrombosis (DVT) after proximal femur fractures in geriatric patients. METHODS: From July 2003 to May 2006, 157 geriatric patients with proximal femur fractures treated with operation were divided into prophylaxis group and control group randomly. There were 82 patients (34 males, 48 females, aged 65-97 years) in prophylaxis group, 30 with femoral neck fracture and 52 with intertrochanteric fracture of femur. There were 75 patients (33 males, 42 females, aged 65-94 years) in control group, 28 with femoral neck fracture and 47 with intertrochanteric fracture of femur. In the prophylaxis group, comprehensive prophylaxis for DVT which included Aspirin, fibrinolytic enzyme, passive and active circumduction of the foot and ankle, CPM management was applied. In the control group, no thromboproxylaxis was taken. All patients in the both groups received color doppler flow imaging (CDFI) examination before operation and on the 7thand 14th days after operation. RESULTS: CDFI found 2 cases of DVT in the prophylaxis group 7 and 14 days after operation respectively, while 21 and 15 cases of DVT in the control group respectively. The incidence of DVT was 48.0% in the control group compared with 4.9% in the prophylaxis group and the reduction was significant (P < 0.01). One patient gave up the intervention due to Melena 3 days after operation in the prophylaxis group. In the control group, 1 patient died 8 days after operation and another died 11 days after operation. Both died of acute pulmonary embolism confirmed by autopsy. CONCLUSION: The comprehensive prophylaxis can significantly decrease the incidence of DVT in geriatric patients after proximal femur fractures. There is no significant adverse effect during the intervention.