CAJ | 학술논문

目的探讨老年人关节置换术后血栓前状态和血液中凝血-纤溶系统指标变化与深静脉血栓形成(DVT)发生的相关性. 方法观察我院2003年1月至2011年6月行髋、膝关节置换术的老年患者400例,根据威尔氏首诊临床(Well' s)评分分为疑似DVT组和非疑似DVT组各200例,再根据患者病情且在其知情同意的情况下分别分为4组:(1)低分子肝素组；(2)间断气囊压迫组；(3)联合治疗组(低分子肝素加间断气囊压迫)；(4)空白对照组:均为拒绝应用预防治疗的患者.术前检测凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2抗纤溶酶复合物(PAP)；术前和术后第4、10天行双下肢血管超声检查. 结果各组患者术后DVT共发生71例(17.8％),肺血栓栓塞症5例(1.3％).疑似DVT组患者术后DVT发生率为28.5％(57例),与非疑似DVT组7.0％(14例)比较,差异有统计学意义(x2=31.66,P＜0.01).疑似DVT组中,联合治疗组DVT发生率与低分子肝素组、间断气囊压迫组及对照组比较差异均有统计学意义(x2值分别为4.89、17.34、18.01,均P＜0.05).非疑似DVT组中,联合治疗组DVT发生率与对照组比较差异有统计学意义(x2=13.64,P＜0.01).术后并发DVT患者术前平均TAT水平为(9.63±3.06)μg/L,高于无DVT患者(2.59±0.87)μg/L,术前平均PAP水平(38.52±21.13)μg/L,低于无DVT患者(69.75±30.26)μg/L,差异均有统计学意义(t值分别为35.70、8.27,均P＜0.01). 结论术前TAT和PAP水平检测对髋、膝关节置换术患者术后发生DVT具有一定的预测价值.应用Well's评分对DVT不同危险程度老年人采用不同的预防措施,可提高预防效果.
목적 탐토노년인관절치환술후혈전전상태화혈액중응혈-섬용계통지표변화여심정맥혈전형성(DVT)발생적상관성. 방법 관찰아원2003년1월지2011년6월행관、슬관절치환술적노년환자400례,근거위이씨수진림상(Well' s)평분분위의사DVT조화비의사DVT조각200례,재근거환자병정차재기지정동의적정황하분별분위4조:(1)저분자간소조；(2)간단기낭압박조；(3)연합치료조(저분자간소가간단기낭압박)；(4)공백대조조:균위거절응용예방치료적환자.술전검측응혈매-항응혈매복합물(TAT)、섬용매-α2항섬용매복합물(PAP)；술전화술후제4、10천행쌍하지혈관초성검사. 결과 각조환자술후DVT공발생71례(17.8％),폐혈전전새증5례(1.3％).의사DVT조환자술후DVT발생솔위28.5％(57례),여비의사DVT조7.0％(14례)비교,차이유통계학의의(x2=31.66,P＜0.01).의사DVT조중,연합치료조DVT발생솔여저분자간소조、간단기낭압박조급대조조비교차이균유통계학의의(x2치분별위4.89、17.34、18.01,균P＜0.05).비의사DVT조중,연합치료조DVT발생솔여대조조비교차이유통계학의의(x2=13.64,P＜0.01).술후병발DVT환자술전평균TAT수평위(9.63±3.06)μg/L,고우무DVT환자(2.59±0.87)μg/L,술전평균PAP수평(38.52±21.13)μg/L,저우무DVT환자(69.75±30.26)μg/L,차이균유통계학의의(t치분별위35.70、8.27,균P＜0.01). 결론 술전TAT화PAP수평검측대관、슬관절치환술환자술후발생DVT구유일정적예측개치.응용Well's평분대DVT불동위험정도노년인채용불동적예방조시,가제고예방효과.
Objective To explore the relationship between the prothrombotic state and blood coagulation-fibrinolysis system changes with deep venous thrombosis(DVT)in aged patients after total joint arthroplasty,and to propose preventive measures.Methods 400 patients who underwent total hip or knee replacement from January 2003 to June 2011 were classified into suspected DVT(n=200 cases)and non-suspected DVT(n=200 cases)according to Well's clinical scoring system.The patients were divided into 4 subgroups based on the measures to prevent DVT:low molecular weigh heparin group,intermittent pneumatic bag compression group,combined above measures group,control group who refused any preventive measures.Plasma thrombin-antithrombin complex(TAT),plasmin-α2 antiplasmin complex(PAP)were determined preoperatively.Venous Doppler ultrasound was performed before surgery,4 d and 10 d after surgery to detect the presence of DVT.Results Totally 71 cases(17.8％)were diagnosed as DVT and 5 cases(1.3％)as pulmonary thromboembolism(PTE).The incidence of DVT in suspected DVT group(28.5％,57 cases)was lower than in non-suspected DVT group(7.0 ％,14 cases)(x2 =31.66,P＜ 0.01).Among patients with suspected DVT,the DVT prevalence in combined measures group(2.0 ％,1 cases)was decreased than in low molecular weigh heparin group(14.0％,7 cases),intermittent pneumatic bag compression (34.0％,17 cases)and control groups(64.0％,32 cases)(x2=4.89,17.34,18.01,all P＜0.05).In the patients with non-suspected DVT,the DVT prevalence in combined measures group(0.0％)was lower than in control group(24.0 ％,12 cases)(x2 =13.64,P＜0.01).The average preoperative level of TAT[(9.63±3.06)μg/L]in patients with DVT was higher than without DVT[(2.59±0.87)μg/L](t=35.70,P＜0.01),while PAP level in patients with DVT[(38.52± 21.13)μg/L]was reduced than without DVT[69.75±30.26)μg/L](t=8.27,P＜0.01).Conclusions The levels of TAT and PAP before total hip or knee replacement are predictive for lower extremity DVT.The clinical effectiveness of Well's scoring on DVT prevention is dependent on the different TAT and PAP state.