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目的 :研究髋关节置换手术患者的抗凝应用时间。方法 :选取在我院进行全髋关节置换的股骨头坏死患者100例,随机分为A、B两组,每组各50例,两组患者在手术后6-8h开始,皮下注射低分子肝素钠5000IU、每天1次,A组服用疗程为10d,B组服用疗程为30d。在全髋关节置换术(THA)前1d与术后第1、10、30d分别抽取A、B两组患者的静脉血样,进行凝血酶-抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段F1+2(F1+2)、D-二聚体(D-dimer)与血浆纤维蛋白原(Fib)等指标的检测。同时,对患者下肢进行静脉造影检查。最后,对检测结果进行比较分析。结果 :相对A组,B组患者在术前1d、术后第10d TAT、F1+2、D-dimer与Fib等指标均无显著差异;相对术前1d,A、B两组患者在术后第10d凝血四项指标均显著升高,差异具有统计学意义。相对A组,B组患者在术后第30d TAT、F1+2、D-dimer等指标显著降低,差异具有统计学意义;相对术前1d,两组患者在术后第30d TAT、F1+2、D-dimer等指标均显著升高,差异具有统计学意义,两组患者术后30d Fib升高不明显;A、B两组患者均有2例出现血栓现象。结论 :髋关节置换术后患者体内的凝血机制能被早期激活,之后的高凝状态可持续30d。尽管延长使用抗凝药物不能够彻底消除患者血液的高凝状态,可是能够在一定程度上起到缓解作用。
Objective: To study the anticoagulation time of patients undergoing hip replacement surgery. Methods: One hundred patients with osteonecrosis of the femoral head who underwent total hip arthroplasty in our hospital were randomly divided into two groups (A and B), 50 cases in each group. The patients in two groups started 6-8 hours after operation and received low molecular weight heparin Sodium 5000IU, 1 day, A group took 10d, B group took 30d. Venous blood samples were collected from patients A and B at 1 day before total hip arthroplasty (THA) and at 1, 10 and 30 days after THA. Thrombin - antithrombin Ⅲ complex (TAT), prothrombin Fragment F1 +2 (F1 +2), D-dimer (D-dimer) and plasma fibrinogen (Fib) and other indicators of detection. At the same time, the patient’s lower limb venous angiography. Finally, the test results for comparative analysis. Results: Compared with group A and group B, there was no significant difference in indexes of TAT, F1 + 2, D-dimer and Fib at 1 day before operation and at 10 days after operation. On the 10th day, the four indexes of coagulation were significantly increased, the difference was statistically significant. Compared with group A, the indexes of TAT, F1 + 2 and D-dimer in group B were significantly decreased at the 30th day after operation, the difference was statistically significant. On the first day after operation, the TAT, F1 + 2 , D-dimer and other indicators were significantly increased, the difference was statistically significant, two groups of patients after 30d Fib increased significantly; A, B two groups of patients with thrombosis. CONCLUSION: The coagulation mechanism in patients after hip replacement can be activated early, and the hypercoagulable state can last for 30 days. Although prolonged use of anticoagulants can not completely eliminate the hypercoagulable state of the patient’s blood, it can relieve to a certain degree.