CAJ | 학술논문

目的探讨髋部骨折老年患者卧床时间与血栓前状态发生的关系.方法髋部骨折后卧床患者166例,年龄≥65岁,性别不限,按入院时卧床时间分为5组:Ⅰ组(n=61)卧床时间＜24 h,Ⅱ组(n=29)卧床时间24 ～ 48 h,Ⅲ组(n=29)卧床时间3～6d,Ⅳ组(n=34)卧床时间7～14d,Ⅴ组(n=13)卧床时间＞14d.采集静脉血测定血小板计数、凝血功能、血浆D-二聚体浓度、血清人血小板α颗粒膜蛋白140(GMP-140)浓度.记录测定指标异常的发生情况.D-二聚体阳性者经双下肢静脉彩色多普勒超声明确有无深静脉血栓.结果与Ⅰ组比较,Ⅱ组、Ⅲ组Fib和D-二聚体异常率、血清GMP-140浓度升高,Ⅳ组血小板计数、Fib和D-二聚体异常率、血清GMP-140浓度升高,Ⅴ组血小板计数异常率升高(P＜0.05),血清GMP-140浓度、Fib和D-二聚体异常率差异无统计学意义(P＞0.05);与Ⅱ组比较,Ⅲ组和Ⅳ组血清GMP-140浓度升高,Ⅳ组Fib和D-二聚体异常率升高(P＜0.05),Ⅲ组Fib和D-二聚体异常率差异无统计学意义(P＞0.05).Ⅳ组血小板计数异常率低于Ⅲ组(P＜0.05).彩色多普勒超声检查均未见深静脉血栓征象.结论髋部骨折老年患者卧床时间超过24 h血栓前状态发生的可能性增加,超过3d为高风险.
목적 탐토관부골절노년환자와상시간여혈전전상태발생적관계.방법 관부골절후와상환자166례,년령≥65세,성별불한,안입원시와상시간분위5조:Ⅰ조(n=61)와상시간＜24 h,Ⅱ조(n=29)와상시간24 ～ 48 h,Ⅲ조(n=29)와상시간3～6d,Ⅳ조(n=34)와상시간7～14d,Ⅴ조(n=13)와상시간＞14d.채집정맥혈측정혈소판계수、응혈공능、혈장D-이취체농도、혈청인혈소판α과립막단백140(GMP-140)농도.기록측정지표이상적발생정황.D-이취체양성자경쌍하지정맥채색다보륵초성명학유무심정맥혈전.결과 여Ⅰ조비교,Ⅱ조、Ⅲ조Fib화D-이취체이상솔、혈청GMP-140농도승고,Ⅳ조혈소판계수、Fib화D-이취체이상솔、혈청GMP-140농도승고,Ⅴ조혈소판계수이상솔승고(P＜0.05),혈청GMP-140농도、Fib화D-이취체이상솔차이무통계학의의(P＞0.05);여Ⅱ조비교,Ⅲ조화Ⅳ조혈청GMP-140농도승고,Ⅳ조Fib화D-이취체이상솔승고(P＜0.05),Ⅲ조Fib화D-이취체이상솔차이무통계학의의(P＞0.05).Ⅳ조혈소판계수이상솔저우Ⅲ조(P＜0.05).채색다보륵초성검사균미견심정맥혈전정상.결론 관부골절노년환자와상시간초과24 h혈전전상태발생적가능성증가,초과3d위고풍험.
Objective To investigate the relationship between bed rest time and development of prethrombotic state in the elderly patients with hip fracture.Methods One hundred and sixty-six patients who stayed in bed after hip fracture,aged ≥65 yr,were divided into 5 groups according to the bed rest time on admission to hospital:bed rest time ＜ 24 h (Ⅰ group,n =61),bed rest time 24-48 h (Ⅱ group,n =29),bed rest time 3-6days (Ⅲ group,n =29),bed rest time 7-14 days (Ⅳ group,n =34),and bed rest time ＞ 14 days (Ⅴ group,n =13).Venous blood samples were collected to measure the platelet count,coagulation function,and concentrations of plasma D-Dimer and serum α-granule membrane protein 140 (GMP-140).The development of abnormality in each index was recorded.The development of deep vein thrombosis in both lower extremities was diagnosed using color Doppler ultrasound in D-Dimer-positive patients.Results Compared with group Ⅰ,the abnormal rate of fibrinogen (Fib) and D-Dimer and serum GMP-140 concentrations were significantly increased in Ⅱ and Ⅲ groups,the abnormal rate of platelet count,Fib and D-Dimer and serum GMP-140 concentrations were increased in lⅣ group,and the abnormal rate of platelet count was increased,and no significant change was found in the serum GMP-140 concentrations and abnormal rate of Fib and D-Dimer in Ⅴ group.Compared with group Ⅱ,the serum GMP-140 concentrations were significantly increased in Ⅲ and Ⅳ groups,the abnormal rate of Fib and D-Dimer was increased in Ⅳ group,and no significant change was found in the abnormal rate of Fib and DDimer in Ⅲ group.The abnormal rate of platelet count was significantly lower in Ⅳ group than in Ⅲ group.Color Doppler Ultrasonography showed no sign of deep vein thrombosis.Conclusion For the elderly patients with hip fracture,the possibility of pre-thrombotic state developed is increased when the bed rest time is more than 24 h,and the patients were classified as high-risk patients when the bed rest time is more than 3 days.