低分子肝素对下肢骨折高龄患者凝血功能的影响及Sonoclot凝血及血小板功能分析仪监测效果评估  

Effect of low molecular weight heparin on coagulation function in elderly patients with lower extremity fracture and evaluation of Sonoclot coagulation and platelet function analyzer

作　　者：何昕昕[1] 丰艳 郭剑颖[1] HE Xinxin;FENG Yan;GUO Jianying(ICU,Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心重症医学科,北京100048

出　　处：《临床与病理杂志》2021年第12期2894-2899,共6页Journal of Clinical and Pathological Research

摘　　要：目的:探究低分子肝素对下肢骨折患者凝血功能的影响及Sonoclot凝血及血小板功能分析仪监测效果,为患者临床治疗提供指导。方法:回顾性分析2017年12月至2019年10月在解放军总医院第四医学中心进行治疗的78例下肢骨折高龄患者,根据治疗方法分为对照组与研究组,每组各39例。对照组术前单纯采用常规治疗,研究组术前在常规治疗的基础上注射低分子肝素改善凝血功能。比较两组患者的手术出血量、术后渗血量、输血量及手术时间等情况以及两组患者手术前后凝血功能指标,同时观察Sonoclot凝血及血小板功能分析仪监测效果,随访1个月,对比两组下肢深静脉血栓(deep venous thrombosis,DVT)发生情况。结果:两组患者手术出血量、术后渗血量、手术时间及输血量均无显著性差异(P>0.05)。手术前,两组患者的血浆凝血酶原时间(prothrombin time,PT)、血浆纤维蛋白原(fibrinogen,FIB)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)比较的差异均无统计意义(均P>0.05);手术后,研究组PT(14.01±0.41)s、APTT(39.59±2.45)s,显著高于对照组的(12.97±0.56)s,(37.26±3.41)s,差异有统计学意义(P <0.05);研究组FIB (2.24±0.51)g/L,显著低于对照组的(3.01±0.48)g/L,差异有统计学意义(P<0.05)。使用普通凝血监测结果显示两组患者的凝血激活时间(activated clotting time,ACT)、凝血速率(clotrate,CR)、血小板功能(platelet function,PF)显示差异均无统计意义(均P> 0.0 5);使用Sonoclot凝血及血小板功能分析仪监测结果显示研究组ACT(187.67±29.27)s,显著高于对照组的(169.12±22.34)s,差异有统计学意义(P<0.05);研究组CR(15.67±5.24)sig/min、PF(1.58±0.94),显著低于对照组的(19.12±5.47)sig/min和(2.67±1.06),差异有统计学意义(P<0.05)。研究组DV T发生率低于对照组,差异有统计学意义(P<0.05)。结论:低分子肝素辅助治疗下肢骨折具有明显的抗凝效果,可改善Objective:To investigate the effect of low molecular weight heparin on coagulation function in patients with lower extremity fracture and the monitoring effect of Sonoclot coagulation and platelet function analyzer,and to provide guidance for clinical treatment of patients.Methods:Seventy-eight elderly patients with lower limb fracture treated in the Fourth Medical Center of PLA General Hospital from December 2017 to October 2019 were retrospectively analyzed.According to the treatment method,they were divided into a control group and a study group,39 cases in each group.The control group was treated with conventional therapy,while the study group was treated with low molecular weight heparin to improve the coagulation function.The blood loss,postoperative bleeding volume,blood transfusion volume,and operation time of the two groups were compared,and the coagulation function indexes of the two groups before and after operation were observed.The monitoring effect of Sonoclot coagulation and platelet function analyzer was observed.The patients were followed up for 1 month,and the incidence of lower extremity deep venous thrombosis(DVT) was compared between the two groups.Results:There was no significant difference between the two groups in the amount of operative bleeding,postoperative bleeding,operation time and blood transfusion(P>0.05).Before operation,there was no significant difference in plasma prothrombin time(PT),plasma fibrinogen(FIB) and activated partial thromboplastin time(APTT) between the two groups(P>0.05).After operation,PT(14.01±0.41) s and APTT(39.59±2.45) s in the study group were significantly higher than those in the control group [(12.97±0.56) s,(37.26±3.41) s,respectively],and the difference was statistically significant(P<0.05).The level of FIB(2.24±0.51) g/L of the study group was significantly lower than that of the control group(3.01±0.48) g/L,and the difference was statistically significant(P<0.05).The monitoring results using common coagulation show that there were no significant

关 键 词：下肢骨折 低分子肝素 抗凝功能 Sonoclot凝血分析仪 血小板功能 

分 类 号：R687.3[医药卫生—骨科学]