抗凝时机对老年全髋关节置换术围手术期深静脉血栓预防的效果及安全性影响观察

Observation on effects and safety of anticoagulation timing on prevention of perioperative DVT in elderly patients undergoing THA

中文关键词: 老年  全髋关节置换术  抗凝时机  深静脉血栓  预防效果  危险因素

英文关键词: elderly  total hip arthroplasty  anticoagulation timing  deep venous thrombosis  preventive effect  risk factor

中文摘要:

      目的 探讨抗凝时机对老年全髋关节置换术(THA)患者围手术期深静脉血栓(DVT)的预防效果及安全性.方法 回顾性选取2021年11月—2023年10月攀枝花市第二人民医院收治的172例行THA老年患者的临床资料,根据伤后至开始抗凝时间分为≤24 h组(n=56),24～48 h组(n=45),＞48 h组(n=71).比较3组的基线资料、围术期DVT发生率及不良反应,分析影响老年THA围手术期发生DVT的危险因素.结果 入院时及术后3 d,3组PLT、PT、aPTT、INR、红细胞压积、血红蛋白(g/L)值差异均无统计学意义(P＞0.05).入院时,血清D-二聚体、NETs水平差异无统计学意义(P＞0.05);术后3 d,血清D-二聚体、NETs水平从高到底依次为＞48 h组、24～48 h组、≤24 h组,差异均具有统计学意义(P＜0.05).年龄、手术时长、抗凝时机、术中出血量、术后卧床时间、血清D-二聚体、血清中性粒细胞胞外陷阱(NETs)是老年THA患者围术期发生DVT的独立危险因素(P＜0.05).结论 早期抗凝(伤后至开始抗凝时间≤24 h)对预防老年髋骨骨折患者围术期DVT具有积极作用.

英文摘要:

      Objective To explore the preventive effects and safety of anticoagulation timing on perioperative deep vein thrombosis(DVT)in elderly patients undergoing total hip arthroplasty(THA).Methods The clinical data of 172 elderly pa-tients who underwent THA in Second People's Hospital of Panzhihua City from November 2021 to October 2023 were retrospec-tively selected.According to the time from injury to the start of anticoagulation,they were divided into ≤24 h group(n=56),24-48 h group(n=45),and＞48 h group(n=71).The baseline data and the incidence of perioperative DVT and adverse re-actions were compared among the three groups.The risk factors for the occurrence of perioperative DVT in elderly THA pa-tients were analyzed.Results At admission and 3 days after the operation,there were no statistically significant differences in the levels of PLT,PT,aPTT,INR,hematocrit,and hemoglobin(g/L)among the three groups(P＞0.05).3 days after the operation,the levels of serum D-dimer and neutrophil extracellular traps(NETs)in the three groups from high to low were the＞48 h group,the 24-48 h group,and the ≤24 h group,respectively,and the differences were statistically significant(P＜0.05).Age,surgical time,anticoagulation timing,intraoperative blood loss,postoperative bed rest time,serum D-dimer,and serum NETs were independent risk factors for perioperative DVT in elderly THA patients(P＜0.05).Conclusion Early anticoagulation(the time from injury to the start of anticoagulation ≤ 24 h)plays a positive role in preventing perioperative DVT in elderly patients with hip fractures undergoing THA.