低分子肝素预防髋关节置换术后深静脉血栓的安全性Safety of low-molecular-weight heparin to prevent deep venous thrombosis after primary hip replacement surgery
李军,朱天岳,马忠泰,柴卫兵,卢宏章,刘震宁
摘要(Abstract):
目的 :研究人工髋关节置换术后使用低分子肝素预防深静脉血栓的安全性。方法 :选择本院 1993年 1月~ 2 0 0 3年 9月实行的 2 0 5例人工全髋关节置换术进行回顾性分析。病人分为两组 ,其中抗凝组 10 9人 ,手术后12~ 18h开始 ,每日用 0 .4~ 0 .6ml低分子肝素钙 (Fraxiparine)腹壁皮下注射 ,共 7d ;非抗凝组 96人 ,术后未注射低分子肝素钙。两组的手术方法及其它术后处理相同。观察出血并发症 ,记录输血量和伤口引流量 ,并对结果进行t检验。结果 :抗凝组伤口引流量和输血量分别为 ( 3 42 .4± 2 3 1.6)ml和 ( 777.9± 5 83 .9)ml ;非抗凝组 ( 2 88.2± 14 1.6)m1和 ( 63 0 .0± 44 4.6)ml,两者间的差异有显著性意义 (P <0 .0 5 )。抗凝组发生严重出血并发症的危险没有增加。结论 :髋关节置换术后 12~ 18h开始 ,每天注射一次低分子肝素预防深静脉血栓可以导致出血量和输血量增加 ,但是并不增加严重出血的危险
关键词(KeyWords): 深静脉血栓;髋关节;人工假体置换;手术后并发症
基金项目(Foundation):
作者(Author): 李军,朱天岳,马忠泰,柴卫兵,卢宏章,刘震宁
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参考文献(References):
- 〔1〕 GallayS ,WaddellJP ,CardellaP ,etal.Ashortcourseoflow molecu lar weightheparintopreventdeepvenousthrombosisafterelectivetotalhipreplacement[J].CJS,1997,40(2):119~123.
- 〔2〕 ColwellCWJr,SpiroTE ,TrowbridgeAA ,etal.Useofenoxaparin,alow molecular weightheparin,andunfractionatedheparinforthepreven tionofdeepvenousthrombosisafterelectivehipreplacement.Aclinicaltrialcomparingefficacyandsafety[J].JBoneJointSurgAm,1994,76(1):3~14.
- 〔3〕 YinB ,BarrattSM ,PowerI,etal.Epiduralhaematomaafterremovalofanepiduralcatheterinapatientreceivinghigh doseenoxaparin[J].BrJAnaesth,1999,82(2):288~290.
- 〔4〕 KoPS ,ChanWF ,SiuTH ,etal.Deepvenousthrombosisaftertotalhiporkneearthroplastyina”low risk”Chinesepopulation[J].JArthro plasty,2003,18(2):174~179.
- 〔5〕 吕厚山,徐斌.人工关节置换术后下肢深静脉血栓形成[J].中华骨科杂志,1999,19(3):155~156.
- 〔6〕 BlanchardJ,MeuwlyJY ,LeyvrazPF ,etal.Preventionofdeep veinthrombosisaftertotalkneereplacement.Randomisedcomparisonbetweenalow molecular weightheparin(nadroparin)andmechanicalprophylaxiswithafoot pumpsystem[J].JBoneJointSurgBr,1999,81(4):654~659.
- 〔7〕 FrancisCW ,PellegriniVDJr,TottermanS ,etal.Preventionofdeep veinthrombosisaftertotalhiparthroplasty.Comparisonofwarfarinanddalteparin[J].JBoneJointSurgAm,1997,79(9):1365~1372.
- 〔8〕 SpiroTE ,JohnsonGJ,ChristieMJ,etal.Efficacyandsafetyofenoxa parintopreventdeepvenousthrombosisafterhipreplacementsurgery[J].AnnInternMed,1994,121(2):81~89.
- 〔9〕 HullR ,RaskobG ,PineoG ,etal.Acomparisonofsubcutaneouslow molecular weightheparinwithwarfarinsodiumforprophylaxisagainstdeep veinthrombosisafterhiporkneeimplantation[J].NEnglJMed,1993,329(19):1370~1376.
- 〔10〕HullRD ,PineoGF ,FrancisC ,etal.Low molecular weightheparinpro phylaxisusingdalteparinincloseproximitytosurgeryvswarfarininhiparthroplastypatients:adouble blind,randomizedcomparison[J].ArchInternMed,2000,160(14):2199~2207.
- 〔11〕MollmannM ,CordS,HolstD ,etal.Continuousspinalanaesthesiaorcontinuousepiduralanaesthesiaforpost operativepaincontrolafterhipre placement[J].EurJAnaesthesiol,1999,16(7):454~461.
- 〔12〕WulfH .Epiduralanaesthesiaandspinalhaematoma[J].CanJAnaesth,1996,43:1260~1271.