比较利伐沙班与低分子肝素对老年转子间骨折股骨近端髓内钉固定术后隐性失血的影响
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摘要
目的:比较分析利伐沙班与低分子肝素对老年转子间骨折股骨近端髓内钉固定术后隐性失血的影响程度。方法:对2015年3月至2017年3月期间在武宁县人民医院接收的老年转子间骨折股骨近端髓内钉固定术患者114例进行研究分析,依据术后抗凝药物使用情况分为参照组和研究组,采用低分子肝素治疗患者为参照组,共52例,采用利伐沙班治疗患者为研究组,共62例,记录两组患者的手术时间、大腿周径增加程度、血红蛋白丢失量、隐性失血量、显性失血量和总失血量,并采用统计学软件进行比较分析。结果:研究组与参照组患者手术时间比较无明显差异,大腿周径增加程度比较无明显差异,P>0.05;参照组与研究组显性失血量比较无明显差异,P>0.05;研究组血红蛋白丢失量显著低于参照组,隐性失血量显著低于参照组,总失血量显著低于参照组,即研究组患者失血控制效果更好,P<0.05。结论:对老年转子间骨折股骨近端髓内钉固定术患者术后应用利伐沙班抗凝药物对术后隐性失血的影响更小,安全性更高,与低分子肝素相比应用价值更高,值得在临床上推广应用。
Objective:To compare the effect of Shaaban and low molecular weight heparin on femoral intertrochanteric fracture of proximal extent induced hidden blood loss after intramedullary nail. Methods: 114 cases from March 2015 to March 2017 in our hospital received proximal femoral intramedullary nail fixation were randomly divided into control group and study group. Patients using low molecular heparin for the treatment included as the reference group(a total of 52 cases), and those with the treatment of Shaaban(a total of 62 cases) were included in the study group. Operation time, increased thigh circumference, hemoglobin loss, hidden Blood loss, dominant blood loss and total blood loss in two groups were analyzed by the statistical software. Results: The study group and control group had no significant difference in operation time, and thigh circumference increase, P>0.05; control group and study group dominant blood loss had no significant difference, P>0.05; hemoglobin loss and blood loss was significantly lower in study group compared with that of control group, P<0.05. Conclusions: For the treatment of femoral intertrochanteric fractures in the elderly with proximal fixation, the side effect of Shaaban on postoperative hidden blood loss is smaller, and with higher safety, compared with low molecular weight heparin, thus it is worthy of clinical application.
Objective:To compare the effect of Shaaban and low molecular weight heparin on femoral intertrochanteric fracture of proximal extent induced hidden blood loss after intramedullary nail. Methods: 114 cases from March 2015 to March 2017 in our hospital received proximal femoral intramedullary nail fixation were randomly divided into control group and study group. Patients using low molecular heparin for the treatment included as the reference group(a total of 52 cases), and those with the treatment of Shaaban(a total of 62 cases) were included in the study group. Operation time, increased thigh circumference, hemoglobin loss, hidden Blood loss, dominant blood loss and total blood loss in two groups were analyzed by the statistical software. Results: The study group and control group had no significant difference in operation time, and thigh circumference increase, P>0.05; control group and study group dominant blood loss had no significant difference, P>0.05; hemoglobin loss and blood loss was significantly lower in study group compared with that of control group, P<0.05. Conclusions: For the treatment of femoral intertrochanteric fractures in the elderly with proximal fixation, the side effect of Shaaban on postoperative hidden blood loss is smaller, and with higher safety, compared with low molecular weight heparin, thus it is worthy of clinical application.
引文
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[2]侯靖钊,包洪卫,程彦晓,等.低分子肝素对老年股骨粗隆间骨折隐性失血及深静脉血栓形成的影响[J].广东医学,2016,37(22):3445-3447.
[3]曾晶山,蔡贤华,李稳,等.隐性失血量对老年股骨转子间骨折术后临床疗效影响的分析[J].中国矫形外科杂志,2016,24(2):106-109.
[4]张冠英.当归补血汤治疗老年粗隆间骨折股骨近端防旋髓内钉术后隐性失血的临床观察[J].中国中医急症,2016,25(5):883-885.
[5]刘国印,张勇,王进,等.老年人营养状况对股骨近端防旋髓内钉治疗围术期隐性失血的影响[J].中华创伤杂志,2016,32(3):207-212.
[6]翁科捷,钟志刚,张育锋,等.老年髋部骨折术后利伐沙班抗凝干预时间对患者出血风险的影响[J].北方药学,2016,13(6):24-25.
[7]王明东.隐性失血对老年股骨转子间骨折术后功能恢复的影响[J].社区医学杂志,2015,13(12):26-28.
[8]刘明东,刘国太,佟杰.围手术期功能康复锻炼联合利伐沙班对THA术后隐性失血的影响[J].浙江临床医学,2017,19(2):241-242.
[9]魏伟强.股骨近端防旋髓内钉治疗老年股骨粗隆间骨折的疗效体会[J].当代医学,2017,23(7):38-39.
[10]Yu W,Zhang X,Wu R,et al.The visible and hidden blood loss of Asia proximal femoral nail anti-rotation and dynamic hip screw in the treatment of intertrochanteric fractures of elderly high-risk patients:a retrospective comparative study with a minimum 3 years of follow-up[J].Bmc Musculoskeletal Disorders,2016,17(1):1-10.