人工关节置换术后隐性失血对下肢深静脉血栓形成的影响  

The Peri-operational Hemorrhage Effect for Deep Vein Thrombosis After Total Hip and Knee Arthroplasty

作　　者：王毅[1] 孙波[2] 富学禹[3] 刘世珑[2] 纪伟华[4] 

机构地区：[1]天津医科大学第一中心临床学院东院普通外科,天津300011 [2]天津中医药大学第一附属医院骨伤科 [3]天津医科大学第一中心临床学院东院骨科,天津市第一中心医院 [4]天津医科大学基础医学院

出　　处：《中国微循环》2008年第5期296-298,共3页Journal of Chinese Microcirculation

摘　　要：目的探讨人工髋、膝关节置换术(Total hip arthroplasty,THA;Total knee arthroplasty,TKA)围手术期失血情况对术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的临床影响。方法92例THA、TKA术后DVT发生情况进行分析。THA为51例(56髋),TKA为41例(49膝)。术后7～10d采用彩色多普勒检查双下肢DVT的发生。对临床失血的相关指标与人工关节置换术后DVT的改变进行了分析。结果术后发生DVT患者共计28例,发生率为30.43%(28/92)。发生DVT的患者临床实际失血总量、隐性失血总量、术后失血总量、术后隐性失血量平均值分别为1648.53ml、844.35ml、1016.17ml、735.87ml,与未发生DVT的患者四项指标比较差异有统计学意义(P<0.05)。结论隐性失血量的增加提高了术后DVT形成的风险。对隐性失血量变化的认识和发生机制的研究有助于人工关节置换术后下肢DVT的防治。Objective To evaluate the influence of the hemorrhage factors for deep vein thrombosis （DVT） aider total hip arthroplasty （THA） and total knee arthroplasty （TKA）. Methods 105 total hip arthroplasty （THA） and total knee arthroplasty （TKA） in 92 patients performed in our hospital from Feb. 2006 to Oct. 2007 were evaluated, which included 56 THAs in 51 patients and 49 TKAs in 41 patients, There were 43 men and 49 women with a mean age of 68.56 years （range,56 - 79）. All patients were given low-molecular-weight heparin for 7-10 days post-operation to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral extremities in all patients before operation and 7-10 days after operation. Nine hemorrhage factors were examined in order to analyze their influences on DVT formation after surgery. Results 28 patients developed DVT after operation. The incidence of DVT was 30.43%（28/92）. Following DVT, the mean total loss was 1648.53 ml, the mean total hidden hemorrhage was 844.35 ml, the mean total loss alter operation was 1016.17 ml and the mean hidden hemorrhage after operation was 735.87 ml, The difference of four factors between DVT and without DVT was significant （P 〉 0.05）. Conclusions The hidden hemorrhage was the risk factor for DVT after THA and TKA. To estimate hidden hemorrhage may result in better treatment of DVT aRer joint arthroplasty.

关 键 词：深静脉血栓 关节成形术 隐性失血 危险因素 

分 类 号：R687.43[医药卫生—骨科学] R364.15[医药卫生—外科学]