| 王跃华,陈锋,周凯,等.低分子肝素联合物理方法预防老年髋关节置换围术期下肢深静脉血栓形成的效果观察[J].安徽医药,2018,22(12):2414-2419. |
| 低分子肝素联合物理方法预防老年髋关节置换围术期下肢深静脉血栓形成的效果观察 |
| Clinical research on low molecular heparin for preventing perioperative lower limb deep vein thrombosis in elderly hip peripheral fracture |
| 投稿时间：2017-02-23 |
| DOI： |
| 中文关键词: 老年髋关节周围骨折 低分子肝素 深静脉血栓 防治 |
| 英文关键词: Elderly hip peripheral fracture Low molecular heparin Deep vein thrombosis Prevention and treatment |
| 基金项目: |
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| 中文摘要: |
| 目的 观察低分子肝素联合物理方法预防老年髋关节周围骨折行髋关节置换围术期下肢深静脉血栓(DVT)形成的效果。 方法 回顾性选取平煤神马医疗集团总医院2015年10月至2016年10月收治的140例行全髋关节置换术老年髋关节周围骨折患者临床资料,采用随机数字表法分为观察组和对照组,每组70例。对照组采用物理疗法预防DVT,观察组在此基础上给予低分子肝素或利伐沙班进行预防,比较两组术后DVT发生率、DVT相关症状发生情况、动态监测凝血功能指标[D-二聚体、纤维蛋白原(FIB)、活化部分凝血活酶时间(ATPP)],随访髋关节Harris评分和生活质量(QOL)评分情况。 结果 观察组DVT发生率8.57%明显低于对照组的21.43%(P＜0.05)；术后1 d、7 d观察组髌上15 cm、髌下10 cm、踝上5 cm肢体周径与对照组差异无统计学意义(均P＞0.05),术后3 d观察组不同部位肢体周径明显低于对照组(P＜0.05)；术后1 d、3 d观察组不同部位肢体体表皮温均低于对照组(P＜0.05)；观察组Homan征、Nenhof征阳性率分别为4.29%、4.29%均明显低于对照组的11.43%、10.00%(均P＞0.05)；两组患者术前、术后1 d、术后3 d D-二聚体、FIB、ATPP水平基本相近(均P＞0.05),术后7 d观察组D-二聚体、FBI水平明显低于对照组、APTT水平明显高于对照组,经组间t检验均P＜0.05；DVT组和无DVT组患者术后1个月、3个月、6个月Harris评分、QOL评分均明显高于术前(P＜0.05),且术后各时点DVT组两项评分均明显高于无DVT组评分(均P＜0.05)。 结论 低分子肝素联合常规物理预防措施可有效预防老年髋关节周围骨折行全髋关节置换术患者DVT,促进术后髋关节功能恢复,改善其生存质量,可作为防治DVT的首选方案。 |
| 英文摘要: |
| Objective To observe the effect of low molecular weight heparin combined with physical methods on preventing the formation of deep venous thrombosis (DVT) in elderly patients with hip fracture. Methods 140 cases of elderly around the hip fracture in our hospital from October 2015 to October 2016 were randomly divided into observation group and control group,with 70 cases in each group.The control group using physical therapy for the prevention of DVT,while the observation group were also treated with low molecular weight heparin or Shaaban of prevention.The incidence of postoperative DVT,the DVT related symptoms,dynamic monitoring of coagulation index [D- two dimer,fibrinogen (FIB),activated partial thromboplastin time(ATPP),score of follow-up Harris hip score and QOL of two groups were compared.Results The incidence of DVT in the observation group was 8.57% lower than 21.43% in the control group (P<0.05).After 1 d,7 d observation group suprapatellar 15 cm,infrapatellar 10 cm,ankle 5 cm limb circumference was lower than the control group but P<0.05.3 d after the operation,the observation group in different parts of limb circumference was significantly lower than the control group (P<0.05).Postoperative 1 d,3 d observed in different parts of the body skin temperature were lower than the control group(P<0.05);The Homan syndrome,Nenhof syndrome positive rate of the observation group were 4.29 %,4.29%,and were significantly lower than the control group 11.43% and 10.00% (P>0.05).Two groups of patients before surgery,postoperative 1D,postoperative two 3D D- dimer,FIB,ATPP level was similar (P>0.05).postoperative 7 d two D- dimer,FBI levels of the observation group were significantly lower than the control group,the level of APTT was significantly higher than the control group,the t test group P<0.05.1 month after operation,the Harris score,QOL score in DVT group and no DVT group were significantly higher than that before operation (P<0.05),and the scores of the DVT group were significantly higher than those of the non DVT group (P<0.05).Conclusions Low molecular weight heparin combined with conventional physical prevention measures can effectively prevent senile hip underwent total hip replacement perioperative deep vein thrombosis of the lower extremity fractures,promote the recovery of hip joint function after operation,improve the quality of life,can be used as the preferred solution of lower extremity deep venous thrombosis prevention after operation. |
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