关节置换术后高凝状态的动态变化分析  

A dynamic analysis on hypercoagulable state after joint arthroplasty

作　　者：翁建豪 许杰[1] 张应彬 李登[1] 蔡志清[1] 苏保华[1] 马若凡[1] 

机构地区：[1]中山大学孙逸仙纪念医院关节外科,广州市510120 [2]中山大学临床医疗8年制2013级,广州市510275

出　　处：《中国矫形外科杂志》2018年第5期395-400,共6页Orthopedic Journal of China

基　　金：广东省科技计划项目(编号：2014A020215009)

摘　　要：[目的]探讨初次髋、膝关节置换术(total hip/knee arthroplasty,THA/TKA)后凝血状况的动态变化,推测目前预防性抗凝过程中的潜在危险因素,为围手术期临床治疗提供依据。[方法]2015年8月～2017年5月前瞻性纳入行初次髋、膝关节置换术患者,分别于术前行TEG及血小板计数检查,术后第1、4、7 d行TEG检查,对比观察各参数的变化趋势。[结果]根据筛选标准纳入研究患者100例,TKA 50例,THA 50例,术前血栓弹力图凝血检查各指标均在正常范围之内;R值在术后4 d降至最低值,K值术后到第7 d呈持续下降趋势;a-angle、MA值术后第7 d升至最高值,与术前相比,差异有统计学意义(P<0.001)。术后反应性高凝状态在髋、膝置换两组间没有显著差异,而高凝状态在术前与术后1、4、7 d之间的变化则有显著差异。根据术后R值、MA值及CI值的持续监测,初次髋、膝关节置换术后高凝在术后7 d呈持续上升趋势。同时随时间的迁延,高凝类型比例变化,血小板型及混合型高凝病例出现并占比渐增。[结论]通过TEG对关节置换围手术期病例机体凝血状态的动态监测,不同病例及不同时间点间凝血状态均存在差异,需加强监测及因个体化特点进行抗凝调整。[Objective] To explore the dynamic changes of hypercoagulability after primary total hip/knee arthroplasty （THA/TKA）, and potential risk factors during prophylactic anti-coagulation therapy for setting up proper perioperative manage- ment. [Methods] From August 2015 to May 2017, this prospective study enrolled patients who underwent primary THAFFKA. Thromboelastogram （TEG） and platelet count were evaluated preoperatively, at 1, 4 and 7 days postoperatively. Variation trends of the parameters were analyzed. [Results] Based on the including and excluding criteria, 100 patients were entered into this study, including 50 patients who received TKA, while the other 50 patients who had THA. The normal TEG parameters were not- ed preoperatively in all of them. Compared with those before operation, the R value declined to the minimum at 4 days postoper- atively, while the K value kept steady decline until 7 days after surgery, moreover, the peak of a-angle and MA value increased to the maximum at 7 days postoperatively, with statistically significant differences （P 〈 0.001）. No differences of reactive hyper- coagulability after surgery were found between the TKA and THA, although significant differences in hypercoagulability were noted among the time points, including that preoperatively, at 1, 4 and 7 days postoperatively. According to TEG monitoring, the hypercoagulability kept rising in the first 7 days after surgery. The hypercoagulability varied with increased proportion of the platelet type and the mixed type over time. [Conclude] With dynamic TEG monitoring during perioperative period, discrepan- cies of blood coagulation status in different patient at different time point do be revealed. Therefore, monitoring and individual- ized regulation of anti-coagulation are necessary.

关 键 词：关节成形术 置换 髋关节 膝关节 高凝 

分 类 号：R687.4[医药卫生—骨科学]