低分子肝素使用时机对关节置换手术失血量和DVT发生率的影响

摘要

Objective To explore the effect of low molecular weight heparin(LMWH)on on blood loss and incidence rates of DVT in THA and TKA.Methods From April 2003 to December 2006,179 patients underwent primary unilateral THA,including 67 males and 112 females with the average age of 68.4 years (range 46-78 years).Using LMWH for 82 patients preoperatively,97 patients postoperatively.83 patients underwent TKA,including 31.males and 52 females with the average age of 65.2 years frange 55-76 vears).Using LMWH for 44 patients preoperatively and 39 patients postoperatively.The amount of total blood loss,the hidden blood loss and the rates of blood loss in the blood volume of patients were calculated.And the DVT incidence rates were compared between LMWH using timing.Results1)In THA preoperatively LMWH using group,the average blood loss was 1638ml,and 38.1% of the blood volume;while in postoperatively LMWH using group,the average blood loss was 1425ml,and 34.2% of the blood volume.In TKA preoperatively LMWH using group,the average blood loss was 1569ml,and 37.4% of the blood volume;while in postoperatively LMWH using group,the average blood loss was 1319 ml,and 31.6% of the blood volume.In THA and TKA group.there were significant differences between the preoperative and postoperative LMWH using groups in the amount of total blood loss,the rates of blood loss in the blood voluree of patients,and the hidden blood loss.However,there were no differences in the rates of hidden blood loss in the total blood loss.2)The incidence rate of DVT was 16.2%in THA group,25.3%in TKA group.Conclusion Preoperatively using LMWH can obviously increase the total blood loss and the hidden blood loss of THA and TKA.Preoperatively and postoperatively using LMWH have no differences in incidence rates of DVT.Postoperative initiate LMWH is safer than preoperative initiate LMWH on preventing DVT in THA and TKA.%目的 探讨全髋和全膝置换手术使用低分子肝素预防深静脉血栓(deep vein thrombosis,DVT)的时机对手术失血量和术后DVT发生率的影响.方法 单侧初次关节置换262例中全髋关节置换179例,术前开始使用低分子肝素82例,术后开始使用97例;全膝关节置换83例,术前开始使用低分子肝素44例,术后开始使用39例.根据患者身高、体重及手术前后红细胞压积和输血量,计算两种给药时机的总失血量、隐性失血量及其占原血容量的比例,并比较DVT发生率.结果 (1)全髋关节置换患者术前开始使用低分子肝素组总失血量平均为1638ml,占原血容量的38.1%;术后开始使用低分子肝素组1425ml,占原血容量的34.2%.全膝关节置换患者术前使用低分子肝素组1569ml,占原血容量的37.4%;术后开始使用低分子肝素组1319ml,占原血容量的31.6%.全髋和全膝置换术前开始使用与术后开始使用低分子肝素比较总失血量与其占原血容量比例的差异均有统计学意义.(2)全髋关节置换DVT的发生率为16.2%,全膝关节置换为25.3%,差异无统计学意义.结论 术前使用低分子肝素可增加全髋和全膝关节置换手术的总失血量和隐性失血量,使用低分子肝素的时机对术后DVT的发生率无影响,术后再使用低分子肝素更安全.