[1]裴宝瑞,吴啸波,李力更,等.应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究[J].中华老年骨科与康复电子杂志,2016,(02):76-80.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
　Pei Baorui,Wu Xiaobo,Li Ligeng,et al.The efficacy of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism in elderly patients before hip fracture surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):76-80.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
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应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2016年02期
页码:
76-80
栏目:
髋部骨折
出版日期:
2016-05-17

文章信息/Info

Title:
The efficacy of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism in elderly patients before hip fracture surgery
作者:
裴宝瑞; 吴啸波; 李力更; 许博文
063000 唐山，华北理工大学附属骨科医院创伤骨科
Author(s):
Pei Baorui;  Wu Xiaobo;  Li Ligeng;  Xu Bowen.
Department of Orthopedics and Traumatology, Orthopaedic Hospital, North China University of Technology, Tangshan 063000, China
关键词:
髋骨折; 　静脉血栓形成; 　肝素; 低分子量
Keywords:
Hip fractures; 　Venous thrombosis; 　Heparin;  Low-Molecular-Weight
DOI:
10.3877/cma.j.issn.2096-0263.2016.02.003
摘要:
目的　评估低分子肝素（low-molecular-weight heparin，LMWH）钙预防剂量与治疗剂量预防老年髋部骨折患者静脉血栓栓塞症（venous thromboembolism，VTE）的安全性。方法　前瞻性收集2013 年9 月至2015 年7 月华北理工大学附属骨科医院创伤骨科收治的符合纳入及排除标准的老年髋部骨折患者125 例，随机分为试验组（n=56）和对照组（n=69）。试验组术前按照LMWH 钙常规治疗血栓剂量预防VTE，对照组应用常规预防血栓剂量，比较两组患者VTE 的发生率及凝血功能的变化。结果　通过下肢彩超及静脉造影检查，试验组患者深静脉血栓的发生率为10.7%（6/56），对照组为26.1%（18/69），差异有统计学意义（χ2=4.709，P ＜ 0.05）。试验组无肺动脉栓塞发生，对照组肺动脉栓塞发生率为2.9%，差异无统计学意义（P ＞ 0.05）。两组患者骨折后2 d 和术前1 d 的活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、血纤蛋白原（fibrinogen， FBG）和血小板计数（platelet court，PLT）比较，差异均无统计学意义（P ＞ 0.05）。结论　老年髋部骨折患者术前采用LMWH 钙治疗剂量预防VTE 的效果优于预防剂量。
Abstract:
Objective　To evaluate the efficacy and reliability of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism (VTE) in elderly patients before hip fracture surgery. Methods　Between September 2013 and July 2015, 125 patients were recruited according to the diagnostic criteria and colleted prospectively. They were divided into experimental group (n=56) and control group (n=69) randomly. Low molecular weight heparin calcium of therapeutic dose was administered for the experimental group versus preventive dose for the control group in prevention of VTE in elderly patients before hip fracture surgery. Comparisons were made between the two groups in respects of the incidence of VTE, APTT, FBG, and PLT. Results　DVT was detected by means of B-mode ultrasonography and venography. The rate of DVT in the experimental group was 10.7% (6/56), and 26.1% (18/69) in control group. The differences between the two groups were statistically significant (χ2=4.709, P<0.05). The PE rate was 2.9% in control group, but the rate of PE in experimental group was zero. The difference of PE rate was not statistically significant between the two groups (P>0.05). The differences of APTT, FBG, and PLT between the two groups were not statistically significant (P>0.05). Conclusion　The efficacy of low molecular weight heparin calcium of therapeutic dose is better than that of preventive dose in prevention of VTE.

参考文献/References:

1 Prensky C, Urruela A, Guss MS, et al. Symptomatic venous thrombo-embolism in low-energy isolated fractures in hospitalised patients [J]. Injury, 2013, 44(8): 1135-1139.
2 邱贵兴. 老年骨质疏松性骨折的治疗策略 [J/CD]. 中华老年骨科与康复电子杂志, 2015, 1(1): 1-5.
3 张英泽. 老年股骨颈骨折诊治中的重要问题 [J/CD]. 中华老年骨科与康复电子杂志, 2015, 1(1): 6-8.
4 Bateman L, Vuppala S, Porada P, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist [J]. Ochsner J, 2012, 12(2): 101-110.
5 中华医学会骨科学分会创伤骨科学组. 创伤骨科患者深静脉血栓形成筛查与治疗的专家共识 [J]. 中华创伤骨科杂志, 2013, 15(12): 1013-1017.
6 王海立, 张奇, 王娟, 等. 血栓风险评估与处置表对预防骨盆与髋臼骨折深静脉血栓形成的临床价值初探 [J]. 中华创伤骨科杂志, 2010, 12(12): 1108-1111.
7 Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians Evidence-Based clinical practice guidelines [J]. Chest, 2012, 141(2 Suppl): e351S-e418S.
8 Bang SM, Jang MJ, Kim KH, et al. Prevention of venous thromboembolism, 2nd edition: Korean Society of Thrombosis and Hemostasis Evidence-based Clinical Practice Guidelines [J]. J Korean Med Sci, 2014, 29(2): 164-171.
9 Caprini JA. Risk assessment as a guide to thrombosis prophylaxis [J]. Curr Opin Pulm Med, 2010, 16(5): 448-452.
10 Lensing AW, Büller HR, Prandoni P, et al. Contrast venography, the Gold standard for the diagnosis of deep-vein thrombosis: improvement in observer agreement [J]. Thromb Haemost, 1992, 67(1): 8-12.
11 Carpintero P, Caeiro JR, Carpintero R, et al. Complications of hip fractures: A review [J]. World J Orthop, 2014, 5(4): 402-411.
12 Marsland D, Mears SC, Kates SL. Venous thromboembolic prophylaxis for hip fractures [J]. Osteoporos Int, 2010, 21(Suppl 4): S593-S604.
13 Heidari N, Jehan S, Alazzawi S, et al. Mortality and morbidity following hip fractures related to hospital thromboprophylaxis policy [J]. Hip Int, 2012, 22(1): 13-21.
14 White JJ, Khan WS, Smitham PJ. Perioperative implications of surgery in elderly patients with hip fractures: an evidence-based review [J]. J Perioper Pract, 2011, 21(6): 192-197.
15 刘亚波, 杨帆, 张力丹. 髋部骨折患者术前静脉血栓栓塞症的预防与治疗[J]. 中华创伤骨科杂志, 2010, 12(12): 1123-1125.
16 曾炳芳, 谢雪涛. 重视创伤肢体深静脉血栓形成的预防 [J]. 中华创伤骨科杂志, 2010, 12(12): 1101-1103.
17 Greenfield LJ, Proctor MC, Rodriguez JL, et al. Posttrauma thromboembolism prophylaxis[J]. J Trauma, 1997,42(1):100-103.
18 Bahl V, Hu HM, Henke PK, et al. A validation study of a retrospective venous thromboembolism risk scoring method [J]. Ann Surg, 2010, 251(2): 344-350.
19 Pannucci CJ, Bailey SH, Dreszer G, et al. Validation of the caprini risk assessment model in plastic and reconstructive surgery patients [J]. J Am Coll Surg, 2011, 212(1): 105-112.
20 Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) [J]. Chest, 2008, 133(6 Suppl): 381S-453S.
21 Prisco D, Cenci C, Silvestri E, et al. Pharmacological prevention of venous thromboembolism in orthopaedic surgery [J]. Clin Cases Miner Bone Metab, 2014, 11(3): 192-195.
22 Shafiq N, Malhotra S, Pandhi P, et al. A randomized controlled clinical trial to evaluate the efficacy, safety, cost-effectiveness and effect on PAI-1 levels of the three low-molecular-weight heparins--enoxaparin, nadroparin and dalteparin. The ESCAPe-END study[J].Pharmacology, 2006,78(3):136-143.
23 Egger B, Schmid SW, Naef M, et al.Efficacy and safety of weight-adapted nadroparin calcium vs. heparin sodium in prevention of clinically evident thromboembolic complications in 1,190 general surgical patients [J]. Dig Surg. 2000;17(6):602-609.
24 Guler T, Polat ZA, Yayci E, et al.Effects of low molecular weight heparins and unfractionated heparin on viability of human umbilical vein endothelial cells [J]. Arch Gynecol Obstet, 2013, 287(2): 217-222.
25 Turpie AG.Can we differentiate the low-molecular-weight heparins?[J].Clin Cardiol, 2000,23 Suppl 1:I4-17.
26 Fuji T, Fujita S, Kawai Y, et al. Safety and efficacy of edoxaban in patients undergoing hip fracture surgery [J]. Thromb Res, 2014, 133(6): 1016-1022.
27 Song JQ, Xuan LZ, Wu W, et al. Low molecular weight heparin?once versus twice for thromboprophylaxis following esophagectomy: a randomised, double-blind and placebo-controlled trial [J]. J Thorac Dis, 2015 ,7(7):1158-1164.
28 Thomas O, Lybeck E, Strandberg K, et al.Monitoring low molecular weight heparins at therapeutic levels: dose-responses of, and correlations and differences between aPTT, anti-factor Xa and thrombin generation assays[J].PLoS One. 2015,10(1): 1-16.
29 杨军, 王毅, 张福江, 等. 血栓弹力图在骨科大手术围手术期抗凝治疗预防深静脉血栓中的动态监测作用 [J]. 中华检验医学杂志, 2015, 38(5): 333-336.
30 Kinov P, Tanchev PP, Ellis M, et al. Antithrombotic prophylaxis in major orthopaedic surgery: an historical overview and update of current recommendations [J]. Int Orthop, 2014, 38(1): 169-175.

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备注/Memo

备注/Memo:
河北省卫生厅医学科学研究重点课题计划（20130665）
更新日期/Last Update: 2016-05-17