术前低分子肝素抗凝对老年髋部骨折围术期安全性及并发症的影响分析  

Effect of low molecular weight heparin anticoagulation before operation on perioperative safety and complications of elderly hip fracture

作　　者：叶欣[1] 赵斌[2] 刘志伟[2] Ye Xin;Zhao Bin;Liu Zhiwei(Department of Cardiology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院心内科,100035 [2]北京积水潭医院急诊科,100035

出　　处：《北京医学》2023年第7期565-568,共4页Beijing Medical Journal

基　　金：北京市医院管理中心“青苗”计划专项(QML20210405);北京积水潭医院“学科骨干”计划专项经费资助(XKGG202204)。

摘　　要：目的探讨术前低分子肝素抗凝对老年髋部骨折患者围术期安全性及并发症的影响。方法选取2017年5月至2020年12月北京积水潭医院急诊科老年髋部骨折患者3819例,根据术前是否规律预防性应用低分子肝素抗凝分为抗凝组(2046例)和未抗凝组(1773例),比较两组住院时间、手术持续时间、输血风险、重症监护室(intensive care unit,ICU)监护比例及围术期并发症的发生率。结果3819例患者中,男1131例,女2688例,年龄65~102岁,中位年龄81.0(74.0,85.0)岁。抗凝组住院时间、电解质紊乱比例低于未抗凝组,差异均有统计学意义(P<0.05);两组患者手术持续时间,输血比例,ICU监护比例,围术期急性冠脉事件、酮症、低血糖、呼吸道感染和泌尿系感染等发生率的比较,差异均无统计学意义(P>0.05)。结论老年髋部骨折患者术前应用低分子肝素抗凝可以减少住院时间,降低电解质紊乱发生率。Objective To explore the effects of preoperative low molecular weight heparin anticoagulation on the perioperative safety and complications of elderly patients with hip fracture.Methods A total of 3819 elderly patients with hip fracture in the emergency department of Beijing Jishuitan Hospital from May 2017 to December 2020 were selected,and were divided into anticoagulation group(2046 cases)and non-anticoagulation group(1773 cases)according to the regularity of preventive anticoagulation with low molecular weight heparin before operation.The hospitalization time,operation duration,blood transfusion risk,ICU monitoring ratio and the incidence of perioperative complications were compared between the two groups.Results Among the 3819 patients,there were 1131 males and 2688 females,aged from 65 to 102 years,with the median age of 81.0(74.0,85.0)years.The hospitalization time and the proportion of electrolyte disturbances in the anticoagulant group were lower than those in the non-anticoagulated group,and the differences were statistically significant(P<0.05).There were no significant differences between the two groups in the operation duration,proportion of blood transfusion,ICU monitoring ratio,acute coronary events occurring,ketosis,hypoglycemia,respiratory tract infection,and proportion of urinary tract infection in the perioperative period(P>0.05).Conclusions Preoperative anticoagulation with low molecular weight heparin can reduce the hospitalization time of elderly patients with hip fracture,and can reduce the incidence of electrolyte disorder.

关 键 词：低分子肝素 安全性 并发症 髋部骨折 术前 老年 

分 类 号：R687.3[医药卫生—骨科学]