| 髋部骨折术后静脉血栓栓塞症的风险预警及多模式预防 |
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Received:April 13, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 阮朝阳 |
RUAN Zhao-yang |
海宁市人民医院骨科,浙江 海宁 314400 |
Department of Orthopaedics,Haining People Hospital,Haining 314400,Zhejiang,China |
zhyangr3061@126.com |
| 何永清 |
HE Yong-qing |
海宁市人民医院骨科,浙江 海宁 314400 |
Department of Orthopaedics,Haining People Hospital,Haining 314400,Zhejiang,China |
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| 曾强华 |
ZENG Qiang-hua |
海宁市人民医院骨科,浙江 海宁 314400 |
Department of Orthopaedics,Haining People Hospital,Haining 314400,Zhejiang,China |
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| 张纲 |
ZHANG Gang |
海宁市人民医院骨科,浙江 海宁 314400 |
Department of Orthopaedics,Haining People Hospital,Haining 314400,Zhejiang,China |
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| 项昶 |
XIANG Chang |
海宁市人民医院骨科,浙江 海宁 314400 |
Department of Orthopaedics,Haining People Hospital,Haining 314400,Zhejiang,China |
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| 朱群威 |
ZHU Qun-wei |
海宁市人民医院骨科,浙江 海宁 314400 |
Department of Orthopaedics,Haining People Hospital,Haining 314400,Zhejiang,China |
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| 期刊信息：《中国骨伤》2012年25卷，第10期，第800-803页 |
| DOI：10.3969/j.issn.1003-0034.2012.10.003 |
| 基金项目:海宁市科技局资助(编号:2009230) |
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目的：探讨采用多模式方式对髋部骨折术后静脉血栓栓塞症预防的有效性和安全性.
方法：2009年3月至2011年7月,根据血栓形成危险因素将患者分为2组,低风险组112例,男47例,女65例;年龄42～88岁,平均(72.40±13.29)岁;高风险组26例,男12例,女14例;年龄65～84岁,平均(78.50±12.76)岁.2组入院后即给予间歇充气加压装置,高风险组术后第1天予低分子肝素0.4 ml,皮下注射,每日1次,连续14 d;低风险组术后给予口服拜阿司匹林100 mg,每日1次,连续14 d;在出院前24 h行多普勒超声检查.术后随访3个月,分别记录下肢深静脉血栓、肺栓塞的发生率和出血并发症的发生情况.
结果：所有患者未发生致命性肺栓塞,1例有症状的肺栓塞发生在低风险组,而高风险组未发现肺栓塞.低风险组术后出现深静脉血栓6例,高风险组术后出现深静脉血栓2例.选取例数较多的骨折切开复位内固定患者比较术后出血量、血红蛋白下降量、血肿及胃肠出血病例数.低风险组分别是(538.10±390.20) ml,(30±19) g/L,0例,1例;高风险组分别是(585.95±403.96)ml,(32±20)g/L,1例,1例,2组比较差异均无统计学意义.
结论：阿司匹林加间歇充气加压装置在预防髋部骨折术后静脉血栓栓塞症方面的疗效与低分子肝素加间歇充气加压装置无明显差别,但在降低出血性并发症和减少心脑血管并发症方面具有潜在优势.多模式血栓栓塞预防方案可以保护患者,作为髋部骨折术后常规预防术后静脉血栓栓塞症的方法. |
| [关键词]:血栓栓塞 静脉 髋骨折 综合预防 |
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| Risk early warning and multimodal prevention of postoperative venous thromboembolism for hip fractures |
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Abstract:
Objective:To study the efficacy and safety of multimodal prevention of postoperative venous thromboembolism for hip fractures.
Methods:From March 2009 to July 2011,preoperatively,patients were assigned to two groups on the basis of an assessment of their risk factors. One hundred and twelve patients were considered to be low risk,involving 47 males and 65 females,with an average age of (72.40±13.29) years ranging from 42 to 88,and were managed with aspirin (100 mg once daily for 14 days) as well as intermittent gasing compression devices. Twenty-six patients were considered to be high risk,involving 12 males and 14 females with an average age of (78.50±12.76) years ranging from 65 to 84,and were managed with low-molecular-weight heparin (0.4 ml,subcutaneous injection once daily for 14 days) and intermittent gasing compression. All patients were underwent Doppler ultrasonography within 24 hours before hospital discharge. All patients were followed-up for 3 months postoperatively. The incidence of deep venous thrombosis of lower limb,pulmonary embolism,gastrointestinal hemorrhage were recorded.
Results:Overall,there were no fatal pulmonary embolism,1 case of symptomatic pulmonary emboli in low risk group,and none were detected in the high-risk group. Deep venous thrombosis was detected in association with 6 (6.25%) of the 112 procedures in the low-risk group and 2 (7.69%) of the 26 operations in the high-risk group. Paitents were selected in opened reduction and internal fixation,the quantity of bleeding,decrease of hemoglobin,hematoma rate,and gastrointestinal hemorrhage rate of low risk group were (538.10±390.20) ml,(30±19) g/L,0,and 1 (1.03%) respectively; those of the high-risk group were (585.95±403.96) mL,(32±20) g/L,1 (4.76%),1 (4.76%),there were no significant different between the two groups,all P > 0.05.
Conclusion:There were no statistic significances between the aspirin as well as intermittent gasing compression devices and the low-molecular-weight heparin and intermittent gasing compression in preventing venous thromboembolism (VTE) in postoperative postoperative venous thromboembolism for hip fractures. However,there are potential advantages to reduce complications of bleeding and cardiovascular disease. Multimodal prevention of postoperative venous thromboembolism can protect postoperative patients with hip fractures. |
| KEYWORDS:Thromboembolism Veins Hip Fractures Universal precautions |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 阮朝阳,何永清,曾强华,张纲,项昶,朱群威.髋部骨折术后静脉血栓栓塞症的风险预警及多模式预防[J].中国骨伤,2012,25(10):800~803 |
| 英文格式: | RUAN Zhao-yang,HE Yong-qing,ZENG Qiang-hua,ZHANG Gang,XIANG Chang,ZHU Qun-wei.Risk early warning and multimodal prevention of postoperative venous thromboembolism for hip fractures[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(10):800~803 |
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