阿司匹林对高龄股骨粗隆间骨折围术期隐性失血的影响  

Influence of Aspirin on Hidden Blood Loss in Perioperative Period of PFNA Fixation in the Elderly with Intertrochaneric Fracture

作　　者：张云海[1] 刘伟[1] 黄东辉[1] 林伟龙[1] Zhang Yunhai;Liu Wei;Huang Donghui;Lin Weilong(Department of Orthopedics,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院骨科,上海20040

出　　处：《老年医学与保健》2018年第4期446-448,共3页Geriatrics & Health Care

摘　　要：目的探讨阿司匹林对高龄股骨粗隆间骨折患者围术期隐性失血的影响。方法回顾分析139例接受股骨近端髓内钉PFNA治疗的80岁及以上高龄患者,将他们分为三组,A组:服用阿司匹林的患者停用阿司匹林,改用低分子肝素;B组:服用阿司匹林患者继续服用阿司匹林;C组:没有服用预防血栓药物的患者入院即使用低分子肝素抗凝治疗,分别收集患者术前日和术后2d时的血红蛋白和红细胞压积值,分别计算血红蛋白和红细胞压积下降值与下降比例,比较组间差异。结果 A组:术前和术后血红蛋白值分别(110.4±14.76)g/L,(92.6±16.60)g/L,降低比率15.43%;术前和术后红细胞压积数值33.32±3.99,28.49±4.68,降低比率14.6%;B组:术前、术后血红蛋白值(111.7±17.12)g/L,(95.3±17.75)g/L,降低比率15.40%,术前、术后红细胞压积数值33.56±4.56,29.01±4.97,降低比率13.20%,C组:术前、术后血红蛋白值(113.04±14.74)g/L,(92.86±20.25)g/L,降低比率数值14.70%,术前,术后红细胞压积数值33.62±3.84,28.98±4.05,降低比率数值14.1%,三组之间血红蛋白和红细胞压积下降值与下降比例没有统计学差异。结论阿司匹林不会比低分子肝素增加高龄股骨粗隆间骨折患者围手术期隐性失血,术前不必停用阿司匹林以及桥接治疗。Objective To discuss the influence of aspirin on hidden blood loss in the perioperative period of PFNA fixation in the elderly with intertrochanteric fracture. Methods A retrospective analysis was made the clinical data of 139 elderly aged over 80 undergoing proximal femoral nail anti-rotation（PFNA） fixation; the elderly were divided into 3 groups： group A, group B and group C; cases in group A stopped the application of aspirin and started to receive subcutaneous injection of low molecular weight heparin（LMWH）; cases in group B kept on the application of aspirin; cases in group C（with no history of anticoagulant therapy） started to receive subcutaneous injection of LMWH after admission; the values of hemoglobin（Hb）and haematocrit（HCT） of all the cases in the 3 groups at the time point of 1 day before surgery and the 2 nd day after surgery were collectecd and decreasing value and decreasing ratio of cases in the 3 groups were calculated; the differences among the 3 groups were compared. Results Before and after surgery in group A,the Hb values were（110.4± 14.76） g/L and（92.6 ±16.60）g/Lwith the decreasing ratio of 15.43% while the HCT values were（33.32±3.99） and（28.49±4.68） with the decreasing ratio of 14.6%; before and after surgery in group B, the Hb values were（111.7±17.12） g/Land（95.3 ± 17.75） g/L with the decreasing ratio of 15.40%% while the HCT values were（33.56±4.56） and（29.01±4.97） with the decreasing ratio of 13.20%; before and after surgery in group C, the Hb values were（113.04±14.74） g/L and（92.86±20.25） g/L with the decreasing ratio of 14.70%%%while the HCT values were（33.62±3.84） and（28.98±4.50） with the decreasing ratio of 14.10%; there existed no obvious differences in Hb and HCT values and the decreasing ratio among the 3 groups. Conclusions Aspirin will not lead to hidden blood loss more than LMWH in the perioperative period of PFNA fixation in the elderly with intertrochaneric fracture, it is unnecessary to stop th

关 键 词：阿司匹林 股骨粗隆间骨折 隐性失血 

分 类 号：R687.3[医药卫生—骨科学]