中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2008年
10期
833-837
,共5页
马卫华%张树栋%慕宏杰%王诗军%毕海勇%刘克贵%赵中原
馬衛華%張樹棟%慕宏傑%王詩軍%畢海勇%劉剋貴%趙中原
마위화%장수동%모굉걸%왕시군%필해용%류극귀%조중원
肝素%低分子量%关节成形术%置换%失血%手术%静脉血栓形成
肝素%低分子量%關節成形術%置換%失血%手術%靜脈血栓形成
간소%저분자량%관절성형술%치환%실혈%수술%정맥혈전형성
Heparin,low-molecular-weight%Arthroplasty,replacement%Blood loss,surgical%Venous thrombosis
目的 探讨全髋和全膝置换手术使用低分子肝素预防深静脉血栓(deep vein thrombosis,DVT)的时机对手术失血量和术后DVT发生率的影响.方法 单侧初次关节置换262例中全髋关节置换179例,术前开始使用低分子肝素82例,术后开始使用97例;全膝关节置换83例,术前开始使用低分子肝素44例,术后开始使用39例.根据患者身高、体重及手术前后红细胞压积和输血量,计算两种给药时机的总失血量、隐性失血量及其占原血容量的比例,并比较DVT发生率.结果 (1)全髋关节置换患者术前开始使用低分子肝素组总失血量平均为1638ml,占原血容量的38.1%;术后开始使用低分子肝素组1425ml,占原血容量的34.2%.全膝关节置换患者术前使用低分子肝素组1569ml,占原血容量的37.4%;术后开始使用低分子肝素组1319ml,占原血容量的31.6%.全髋和全膝置换术前开始使用与术后开始使用低分子肝素比较总失血量与其占原血容量比例的差异均有统计学意义.(2)全髋关节置换DVT的发生率为16.2%,全膝关节置换为25.3%,差异无统计学意义.结论 术前使用低分子肝素可增加全髋和全膝关节置换手术的总失血量和隐性失血量,使用低分子肝素的时机对术后DVT的发生率无影响,术后再使用低分子肝素更安全.
目的 探討全髖和全膝置換手術使用低分子肝素預防深靜脈血栓(deep vein thrombosis,DVT)的時機對手術失血量和術後DVT髮生率的影響.方法 單側初次關節置換262例中全髖關節置換179例,術前開始使用低分子肝素82例,術後開始使用97例;全膝關節置換83例,術前開始使用低分子肝素44例,術後開始使用39例.根據患者身高、體重及手術前後紅細胞壓積和輸血量,計算兩種給藥時機的總失血量、隱性失血量及其佔原血容量的比例,併比較DVT髮生率.結果 (1)全髖關節置換患者術前開始使用低分子肝素組總失血量平均為1638ml,佔原血容量的38.1%;術後開始使用低分子肝素組1425ml,佔原血容量的34.2%.全膝關節置換患者術前使用低分子肝素組1569ml,佔原血容量的37.4%;術後開始使用低分子肝素組1319ml,佔原血容量的31.6%.全髖和全膝置換術前開始使用與術後開始使用低分子肝素比較總失血量與其佔原血容量比例的差異均有統計學意義.(2)全髖關節置換DVT的髮生率為16.2%,全膝關節置換為25.3%,差異無統計學意義.結論 術前使用低分子肝素可增加全髖和全膝關節置換手術的總失血量和隱性失血量,使用低分子肝素的時機對術後DVT的髮生率無影響,術後再使用低分子肝素更安全.
목적 탐토전관화전슬치환수술사용저분자간소예방심정맥혈전(deep vein thrombosis,DVT)적시궤대수술실혈량화술후DVT발생솔적영향.방법 단측초차관절치환262례중전관관절치환179례,술전개시사용저분자간소82례,술후개시사용97례;전슬관절치환83례,술전개시사용저분자간소44례,술후개시사용39례.근거환자신고、체중급수술전후홍세포압적화수혈량,계산량충급약시궤적총실혈량、은성실혈량급기점원혈용량적비례,병비교DVT발생솔.결과 (1)전관관절치환환자술전개시사용저분자간소조총실혈량평균위1638ml,점원혈용량적38.1%;술후개시사용저분자간소조1425ml,점원혈용량적34.2%.전슬관절치환환자술전사용저분자간소조1569ml,점원혈용량적37.4%;술후개시사용저분자간소조1319ml,점원혈용량적31.6%.전관화전슬치환술전개시사용여술후개시사용저분자간소비교총실혈량여기점원혈용량비례적차이균유통계학의의.(2)전관관절치환DVT적발생솔위16.2%,전슬관절치환위25.3%,차이무통계학의의.결론 술전사용저분자간소가증가전관화전슬관절치환수술적총실혈량화은성실혈량,사용저분자간소적시궤대술후DVT적발생솔무영향,술후재사용저분자간소경안전.
Objective To explore the effect of low molecular weight heparin(LMWH)on on blood loss and incidence rates of DVT in THA and TKA.Methods From April 2003 to December 2006,179 patients underwent primary unilateral THA,including 67 males and 112 females with the average age of 68.4 years (range 46-78 years).Using LMWH for 82 patients preoperatively,97 patients postoperatively.83 patients underwent TKA,including 31.males and 52 females with the average age of 65.2 years frange 55-76 vears).Using LMWH for 44 patients preoperatively and 39 patients postoperatively.The amount of total blood loss,the hidden blood loss and the rates of blood loss in the blood volume of patients were calculated.And the DVT incidence rates were compared between LMWH using timing.Results1)In THA preoperatively LMWH using group,the average blood loss was 1638ml,and 38.1% of the blood volume;while in postoperatively LMWH using group,the average blood loss was 1425ml,and 34.2% of the blood volume.In TKA preoperatively LMWH using group,the average blood loss was 1569ml,and 37.4% of the blood volume;while in postoperatively LMWH using group,the average blood loss was 1319 ml,and 31.6% of the blood volume.In THA and TKA group.there were significant differences between the preoperative and postoperative LMWH using groups in the amount of total blood loss,the rates of blood loss in the blood voluree of patients,and the hidden blood loss.However,there were no differences in the rates of hidden blood loss in the total blood loss.2)The incidence rate of DVT was 16.2%in THA group,25.3%in TKA group.Conclusion Preoperatively using LMWH can obviously increase the total blood loss and the hidden blood loss of THA and TKA.Preoperatively and postoperatively using LMWH have no differences in incidence rates of DVT.Postoperative initiate LMWH is safer than preoperative initiate LMWH on preventing DVT in THA and TKA.
