低分子肝素联合压力泵对髋部骨折围术期DVT临床疗效及凝血功能作用  

Clinical effect of LMWH and pressure pump on DVT and coagulation in perioperative period of hip fracture

作　　者：简蔚泓[1] 廖学勤[1] 兰小勇[1] 叶栋[1] 

机构地区：[1]南昌市第一医院创伤骨科

出　　处：《中国生化药物杂志》2017年第1期133-135,共3页Chinese Journal of Biochemical Pharmaceutics

摘　　要：目的 探讨低分子肝素（low molecular weight heparin,LMWH）与压力泵对髋部骨折围术期深静脉血栓（deep vein thrombosis,DVT）临床疗效,分析其对凝血功能的影响。方法 回顾性分析95例髋部骨折手术治疗患者的临床资料,根据其预防DVT的治疗方式分为LMWH治疗组42例和LMWH联合压力泵组53例。观察2组患者围手术期DVT发生率、患肢肿胀程度,比较2组患者术后凝血功能指标、血液流变学和髋关节功能恢复的差异。结果 联合治疗组围手术期DVT发生率为1例（1.89%）,低于LMWH治疗组的6例（14.29%）（χ2=5.278,P=0.022）;术后2周,联合治疗组患者的大腿周径差和小腿周径差均小于LMWH治疗组（P〈0.05）;手术后2周,2组的凝血酶原时间（prothrombin time,PT）、活化部分凝血活酶时间（activated partial thromboplastin time,APTT）水平较手术前降低,D-二聚体（D-dimer,D-D）较手术前增高（P〈0.05）,而2组间比较无差异。手术后2周,联合治疗组的血浆粘度、全血粘度和凝血因子水平低于LMWH治疗组（P〈0.05）。术后3个月,联合治疗组的髋关节Harris运动功能评价表（functional independence measure,FIM）得分高于LMWH治疗组（P〈0.05）。结论 LMWH与压力泵联合应用可明显降低髋部骨折患者围手术期DVT发生率,改善患者的凝血功能和髋关节功能。Objective To investigate the clinical effect of low molecular weight heparin （LMWH） and pressure pump on perioperative deep vein thrombosis （DVT） in patients with hip fracture and analyze the effect of LMWH on coagulation function. Methods Retrospective analysis o f 95 cases hip fractures patients with clinical data, according to the preventive medication of DVT were divided into LMWH group of 42 cases and LMWH joint pressure pump group of 53 cases. The incidence rate of DVT and the degree of limb swelling after operation in two groups were observed. The differences of blood coagulation function indexes, blood rheology and hip function recovery were compared between the two groups. Results The the incidence rate of DVT in combination group was 1.89% （1 cases）, lower than LMWH group of 14.29% （6 cases ）（x^2=5.278,/M）.022）. After two weeks treatment, the difference of anterior thigh circumference and calf circumference in combination group was less than LMWH group （P〈0.05）. The prothrombin time （PT） and activated partial thromboplastin time （APTT） in two groups post-treatment were lower than those pre-treatment, the D-dimer （D-D） was higher than that pre-treatment（P 〈0.05）,but there was no significant difference between two groups. After 3 months treatment, the Harris functional independence measure （FIM） in combination group was higher than that in LMWH group （P〈0.05）. Conclusion LMWH combined with pressure pump could significantly reduce the incidence of perioperative DVT in patients with hip fracture, improve the blood coagulation function and hip function.

关 键 词：低分子肝素 压力泵 联合 髋部骨折 深静脉血栓 凝血功能 

分 类 号：R274.1[医药卫生—中医骨伤科学]