| 菅志飞,孙 维,杨华清,喻 伟,沈小辉.不同抗凝策略对急性多发性创伤伴下肢骨折患者DVT和肺栓塞发生率的影响[J].,2019,19(21):4165-4169 |
| 不同抗凝策略对急性多发性创伤伴下肢骨折患者DVT和肺栓塞发生率的影响 |
| Effects of Different Anticoagulation Strategies on the Incidence Rates of DVT and Pulmonary Embolism in patients with Acute Multiple Trauma Complicated with Lower Limbs Fractures |
| 投稿时间：2019-04-04 修订日期：2019-04-30 |
| DOI：10.13241/j.cnki.pmb.2019.21.037 |
| 中文关键词: 急性多发性创伤伴下肢骨折 下肢深静脉血栓 肺栓塞 抗凝 |
| 英文关键词: Acute multiple trauma complicated with lower limbs fractures Deep vein thrombosis Pulmonary embolism Anticoagulation |
| 基金项目:湖北省卫生计生委科研基金项目(WJ2015MB290)；十堰市科技计划项目(16Y66) |
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| 中文摘要: |
| 摘要 目的：探讨不同抗凝策略对急性多发性创伤伴下肢骨折患者下肢深静脉血栓(DVT)和肺栓塞发生率的影响。方法：将2017年1月～2017年12月我院收治的200例急性多发性创伤伴下肢骨折患者按照随机数表法分为观察组和对照组，每组各100例。对照组予以低分子肝素钙，观察组予以利伐沙班。随访1月，比较两组患者DVT、肺栓塞的发生情况，术前、术后1 d、术后5 d血栓弹力图指标、血液流变学的变化，术中失血量、术后引流量及者用药不良反应的发生情况。结果：①随访1月，观察组DVT的发生率显著低于对照组(P<0.05)，两组肺栓塞的发生率对比差异无统计学意义(P>0.05)；②术后1 d时，两组R时间、K时间均短于术前(P<0.05)，α角、MA值、中切全血粘度、低切全血粘度、血浆粘度均高于术前(P<0.05)，但两组以上指标组间对比差异无统计学意义(P>0.05)；术后5 d时，两组R时间、K时间均长于术前1 d时(P<0.05)，α角、MA值、中切全血粘度、低切全血粘度、血浆粘度均低于术前1 d时(P<0.05)，且观察组以上指标改变幅度均大于对照组(P<0.05)；③两组术中失血量、术后引流量、不良反应发生率对比差异无统计学意义(P>0.05)。结论：利伐沙班和低分子肝素钠均有利于改善急性多发性创伤伴下肢骨折患者血液流变学和凝血功能，但前者效果更佳，更有利于降低DVT的发生风险。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effects of different anticoagulation strategies on the incidence rates of deep vein thrombosis (DVT) and pulmonary embolism in patients with acute multiple trauma and lower limbs fractures. Methods: 200 patients with acute multiple trauma and lower limbs fractures who were treated in our hospital from January 2017 to December 2017 were divided into observation group and control group according to the random number table method, with 100 cases in each group. Control group was given low-molecular-weight heparin calcium, and observation group was given rivaroxaban. After 1 month of follow-up, the occurrence of DVT and pulmonary embolism, thrombelastogram indexes and hemorheology before operation and at 1 d and 5 d after operation, and intraoperative blood loss, postoperative drainage volume and occurrence of adverse drug reactions were compared between the two groups. Results: At 1 month of follow-up, the incidence rate of DVT was lower in observation group was significantly lower than that in control group (P<0.05), and there was no significant difference in the incidence rate of pulmonary embolism between the two groups (P>0.05). At 1d after operation, the R time and K time in the two groups were shorter than those before operation (P<0.05), and the α angle, MA value and middle shear whole blood viscosity, low shear whole blood viscosity and plasma viscosity were all higher than those before operation (P<0.05), but there was no significant difference in the above indexes between the two groups (P>0.05). At 5d after operation, the R time and K time in the two groups were longer than those at 1d before operation (P<0.05), and the α angle, MA value and middle shear whole blood viscosity, low shear whole blood viscosity and plasma viscosity were all lower than those at 1d before operation (P<0.05), and the changes of above indexes in observation group were greater than those in control group (P<0.05). There were no statistically significant differences in intraoperative blood loss, postoperative drainage volume and incidence rate of adverse reactions between the two groups (P>0.05). Conclusion: Rivaroxaban and low-molecular-weight heparin sodium are beneficial to improve the hemorheology and coagulation function of patients with acute multiple trauma complicated with lower limbs fractures, but the former can more effectively reduce the risk of DVT. |
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