血凝酶与低分子肝素联合应用对≥90岁股骨粗隆间骨折病人预后的影响  

Effect of hemocoagulase combined with low-molecular-weight heparin on the prognosis of super-aged patients with intertrochanteric femur fractures receiving internal fixation

作　　者：陆奇峰[1] 李庆嵩[1] 唐根林[1] 缪阿凤 LU Qifeng;LI Qingsong;TANG Genlin;MIAO Afeng(Department of Orthopaedics,Taizhou People’s Hospital,Taizhou 225300,China)

机构地区：[1]泰州市人民医院创伤骨科,江苏省泰州市225300

出　　处：《实用老年医学》2025年第2期153-157,共5页Practical Geriatrics

摘　　要：目的探究血凝酶与低分子肝素联合应用对超高龄(≥90岁)股骨粗隆间骨折病人预后及生存时间的影响。方法选取2016年1月至2019年12月在我院行股骨近端防旋髓内钉(PFNA)手术治疗的股骨粗隆间骨折病人67例为研究对象,根据围术期抗凝方式分为血凝酶与低分子肝素联合组(血凝酶联合组,n=35)和单纯低分子肝素组(肝素组,n=32)。比较2组术中出血、术后引流量、术后隐性失血量、手术前后Hb水平以及生存时间等数据,分析病人远期预后的影响因素。结果肝素组隐性失血量为(627.19±88.7)mL,明显高于血凝酶联合组的(521.71±92.75)mL(P<0.001)。术后1 d及术后3 d时肝素组的Hb水平均明显低于血凝酶联合组(P<0.05)。术后30个月内血凝酶联合组的累积生存率均高于肝素组,2组生存曲线比较,差异有统计学意义(P=0.025)。Cox比例风险模型结果显示,单纯低分子肝素治疗和高美国麻醉医师协会(ASA)分级显著增加超高龄病人的死亡风险。结论血凝酶与低分子肝素联合应用能够降低超高龄股骨粗隆间骨折病人术后隐性失血,并可改善病人远期预后。Objective To explore the effect of hemocoagulase combined with low-molecular-weight heparin(LMWH)on the prognosis and the survival time in the patients aged≥90 years old with intertrochanteric femur fractures(ITFF)who received internal fixation operation.Methods From January 2016 to December 2019,a total of 67 patients aged≥90 years old with ITFF who underwent proximal femoral nail antirotation(PFNA)operation were enrolled in this study.According to the perioperative anticoagulation therapy,they were divided into the combination group using hemocoagulase and LMWH(combination group,n=35)and LMWH group(n=32)using LMWH alone.The intraoperative blood loss,postoperative drainage volume,postoperative hidden blood loss,preoperative and postoperative hemoglobin(Hb)levels and survival time were compared between the two groups,and the factors affecting the long-term prognosis of the super-aged patients were analyzed.Results The hidden blood loss in LMWH group was 627.19±88.7 mL,compared with 521.71±92.75 mL in combination group(P<0.001).The Hb level in LMWH group was significantly lower than that in combination group 1 day and 3 days after operation(P<0.05).The cumulative survival rate within 30 months after operation in combination group was significantly higher than that in LMWH group(P=0.025).Cox proportional hazards model showed that LMWH therapy alone and high ASA classification significantly increased the risk of death in the super-aged patients with ITFF undergoing PFNA operation.Conclusions The combination of thrombin and LMWH can reduce postoperative hidden blood loss in super-aged patients with ITFF undergoing PFNA operation,and improve the prognosis of the patients.

关 键 词：股骨粗隆间骨折 超高龄 预后 生存时间 

分 类 号：R687.3[医药卫生—骨科学]