外伤早期抗凝治疗对降低髋部骨折患者下肢深静脉血栓发生率的影响  

Effect of anticoagulation on the incidence of deep venous thrombosis in lower limb in patients with hip fracture at early stage of injury

作　　者：罗海杰[1] 黄志聪[1] 陈子广 成石阳 苏晓恩[1] 邓海棠[1] 

机构地区：[1]广东省肇庆市第一人民医院,526000

出　　处：《临床医学》2017年第4期24-26,共3页Clinical Medicine

摘　　要：目的探讨髋部骨折早期使用抗凝药物对下肢深静脉血栓发生率的影响,并初步探讨其原因,为临床提供指导方案。方法 2013年3月至2015年6月80例髋部骨折患者,均行手术治疗,其中40例在入院时即开始口服利伐沙班(观察组),术前24 h停药,术后8 h开始继续使用;40例在术后8 h开始口服利伐沙班(对照组),疗程均为5周。观察两组用药期间不良反应,采用静脉彩超检测血栓发生情况。结果观察组血浆活化凝血时间(ACT)、D-二聚体水平及血小板聚集率低于对照组(P<0.05)。入院时两组下肢深静脉血栓发生率比较差异未见统计学意义(P>0.05),而术前和术后5周观察组均低于对照组,差异有统计学意义(P<0.05)。在不良反应方面,两组均未发生致命性大出血,观察组和对照组各出现切口渗血1例,观察组1例出现皮下瘀斑,停药后缓解。切口引流量观察组为(445.5±102.7)ml,对照组为(425.4±121.6)ml,两组比较差异未见统计学意义(P>0.05)。结论外伤早期口服利伐沙班有利于降低下肢深静脉血栓的发生率,并不提高出血的发生率,其机制与降低血浆ACT和D-二聚体水平有关。Objective To investigate the effect of anticoagulant drugs on the incidence of deep venous thrombosis in lower limb in patients with hip fracture at early stage of injury, and to investigate the causes of the deep venous thrombosis, so as to provide the guidance for clinical treatment. Methods From March 2013 to June 2015, 80 patients with hip fracture underwent operation, and 40 cases were treated with oral administration of Shaaban at admission （observation group） , and stopped medication 24 hours before operation, continued medication 8 h after medication ; another 40 cases were treated with oral administration of Shaaban 8 h after medication（ control group）. The treatment courses were 5 weeks. The adverse reactions of the two groups were observed, and the venous color Doppler ultrasound was used to detect the thrombosis. Results Theplasma activated coagulation time （ACT） , D-dimers and platelet aggregation rates in the observation group were lower than those in the control group （ P 〈 0. 05 ）. There was no significant difference in the incidence of deep venous thrombosis in lower limb at admission between the two groups （ P 〉 0. 05 ）, but the incidences of deep venous thrombosis in lower limb before operation and 5 weeks after operation in the observation group were lower than those in the control group, and the differences were significant（ P 〈 0. 05 ）. In terms of adverse reactions, the two groups did not have fatal bleeding, the observation group and the control group both had 1 case of wound bleeding, and the observation group had 1 case of subcutaneous ecchymosis, which was alleviated after discontinuation of drugs. The incision induced flow in observation group was （445.5 ± 102.7） ml, and that in the control group was （425.4 ± 121.6） ml, the difference was not significant between the two groups （P 〉 0. 05）. Conclusion Early oral administration of Shaaban is beneficial to reduce the incidence of deep venous thrombosis of lower extremity, without increasing th

关 键 词：抗凝 髋部骨折 下肢深静脉血栓 

分 类 号：R687.3[医药卫生—骨科学]