髋部骨折术后患者血栓弹力图联合凝血四项检测各项指标水平变化与小腿肿胀淤斑的关系  

The Relationship between the Changes of Each Index Level of Thromboelastography Combined with Four Coagulation Tests and Swelling and Ecchymosis of the Calf in Patients with Hip Fracture after Operation

作　　者：陈敏 CHEN Min(Department of Orthopedics,Longyan People's Hospital,Longyan,Fujian Province,364000 China)

机构地区：[1]福建省龙岩人民医院骨科,福建龙岩364000

出　　处：《中外医疗》2022年第14期23-26,31,共5页China & Foreign Medical Treatment

摘　　要：目的探讨髋部骨折患者血栓弹力图(thromboela-stogram,TEG)联合凝血四项各项指标水平变化与小腿肿胀淤斑的关系。方法随机选取2019年6月—2021年9月于该院行手术治疗的髋部骨折患者60例。根据手术方式,将行髋部骨折内固定术的21例患者设为内固定组,将行人工关节置换术(artificial joint replacement,AJR)的39例患者设为AJR组,比较两组患者术后TEG参数及凝血四项指标及术后小腿肿胀淤斑块发生情况,应用ROC曲线分析人工关节置换术后患者和髋部骨折内固定术后患者各项指标水平变化预测小腿肿胀淤斑的效果。结果术后AJR组与内固定组凝血因子激活时间(reaction time,R)分别为(6.95±1.27)、(6.72±1.42)min,血细胞凝聚成块时间(kinetics of clot development,K)分别为(1.53±0.45)、(1.59±0.44)min,最大振幅(maximal amplitude,MA)分别为(63.89±5.43)、(64.99±4.66)mm,Angle值分别为(66.83±6.96)、(67.72±6.04)°,差异无统计学意义(P>0.05);术后AJR组与内固定组患者纤维蛋白原(fibrinofen,FIB)分别为(3.84±0.98)、(3.91±0.97)g/L,凝血酶时间(thrombin time,TT)分别为(17.64±1.80)、(17.89±1.79)s,活化部分凝血酶原时间(activated partial thromboplastin time,APTT)分别为(25.15±2.51)、(26.01±2.87)s,凝血酶原时问(prothrombin time,PT)分别为(11.28±0.75)、(11.46±0.63)s,差异无统计学意义(P>0.05);术后AJR组与内固定组中存在小腿肿胀淤斑的患者共8例,ROC曲线分析显示,R、MA、FIB、APTT及联合预测小腿肿胀淤斑发生的AUC值为0.719、0.685、0.861、0.762、0.918。结论TEG参数及凝血四项指标预测小腿肿胀瘀斑发生的效果良好,可作为人工关节置换术和髋部骨折内固定术后患者小腿肿胀瘀斑早期诊断的重要指标。Objective To explore the relationship between the changes of thromboelastography(thromboelastogram,TEG)combined with the four indexes of coagulation and the swelling and ecchymosis of the calf in patients with hip fracture.Methods A total of 60 patients with hip fracture who underwent surgery in the hospital from June 2019 to September 2021 were randomly selected.According to the operation method,21 patients who underwent internal fixation of hip fracture were set as the internal fixation group,and 39 patients who underwent artificial joint replacement(AJR)were set as the AJR group.The postoperative TEG parameters,four coagulation indexes and the occurrence of postoperative calf swelling and ecchymosis were compared between the two groups of patients.The ROC curve was used to analyze the effect of predicting the effect of calf swelling and ecchymosis in patients after artificial joint replacement and after hip fracture internal fixation.Results After surgery,the activation time(R)of coagulation factors in the AJR group and the internal fixation group were(6.95±1.27)min and(6.72±1.42)min,respectively,and the kinetics of clot development(K)in the AJR group and the internal fixation group were(1.53±0.45)min,(1.59±0.44)min,the maximal amplitude(MA)were(63.89±5.43)mm,(64.99±4.66)mm,and the angle values were(66.83±6.96)°,(67.72±6.04)°,the difference was not statistically significant(P>0.05).After operation,the fibrinogen(FIB)of the AJR group and the internal fixation group were(3.84±0.98)g/L,(3.91±0.97)g/L,and the thrombin time(TT)were(17.64±1.80)s,(17.89±1.79)s,activated partial thromboplastin time(APTT)were(25.15±2.51)s,(26.01±2.87)s,prothrombin time(PT)were(11.28±0.75)s and(11.46±0.63)s,respectively,the difference was not statistically significant(P>0.05).After operation,there were 8 patients with calf swelling and ecchymosis in AJR group and internal fixation group.ROC curve analysis showed that the AUC value of R,MA,FIB,APTT and their combination for predicting the occurrence of calf swelling and

关 键 词：血栓弹力图 凝血四项 下肢静脉血栓 髋部骨折 应用价值 

分 类 号：R4[医药卫生—临床医学]