低分子肝素钙致全髋关节置换术患者大量渗血  

A large amount of blood oozing induced by low-molecular-weight heparin calcium in patients undergoing total hip joint replacement

作　　者：陈东阳[1] 王惠冰[1] 顾新[2] 蒋青[1] 袁涛[1] 徐志宏[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,南京210008 [2]南京大学医学院附属鼓楼医院药剂科,南京210008

出　　处：《药物不良反应杂志》2009年第2期135-136,共2页Adverse Drug Reactions Journal

摘　　要：例1,男,79岁,因右股骨颈骨折入院。患者在接受全髋关节置换术前1天晚开始给予低分子肝素钙3075U皮下注射。术后给予头孢噻肟钠、七叶皂甙钠、奥美拉唑,并插管引流。术后第3天拔除引流管,之后2h内引流口流出总量达400ml的血色液体。凝血试验示:PT14.6s,APTT54.7s,TT13.7s,纤维蛋白原3.2g/L,抗凝血酶原Ⅲ68.6s。血常规示:Hb76g/L,PLT188×109/L。立即肌内注射血凝酶1000U,6h后再注射1000U,并输新鲜血浆800ml,红细胞悬液5U。术后第3天停用低分子肝素钙,次日复查凝血试验依然正常,伤口未再出现渗血。例2,74岁女性患者因右股骨颈骨折入院。全髋关节置换术前12h,给予低分子肝素钙3075U皮下注射。手术过程中患者渗血较多,凝血试验示:APTT58.7s。立即给予鱼精蛋白30mg静脉注射,血凝酶1000U肌内注射。术后停用低分子肝素钙。术后第2天患者伤口未出现明显渗血。Patient 1, a 79-year-old man, was hospitalized with fracture of right femoral neck. The patient started receiving SC low-molecular-weight heparin calcium 3 075 U in the evening of the day before undergoing total hip joint replacement. Cefotaxime sodium, sodium aescinate, and omeprazole were given and a drain was inserted after surgery. On day 3 after surgery, the drain was removed, then a total of 400 ml of blood-stained fluid flowed from his drain site within 2 hours. Coagulation test revealed the following： PT 146 s, APTT 54.7 s, TT 13.7 s, FIB 3.2g/L, and AT m 68.6 s. Routine blood test showed a Hb level of 76 g/L and a PLT count of 188 × 10^9/L. IM thrombin 1 000 U was given immediately. Six hours later, IM thrombin 1 000 U, an IV infusion of fresh plasma 800 ml and 5 units of erythrocyte suspension were administered. On day 3 after surgery, low-molecular-weight heparin calcium was discontinued. The following day, a repeated coagulation test remained normal. Blood oozing from incision site did not recur. Patient 2, a 74-year-old woman was hospitalized with fracture of right femoral neck. She received SC low-molecular-weight heparin calcium 3 075 U 12 hours before undergoing total hip joint replacement. During the surgery, the patient experienced more blood oozing. Coagulation test revealed an APTT of 58.7 s. Ⅳ protamine 30 mg and IM thrombin 1 000 U were given immediately. Lowmolecular-weight heparin calcium was stopped after surgery. Her wound did not showed marked blood oozing on day 2 after surgery.

关 键 词：低分子肝素钙 渗血 不良反应 

分 类 号：R595.3[医药卫生—内科学]