老年股骨粗隆间骨折患者术后隐性失血与抗凝的临床观察.docVIP

精品论文 参考文献 老年股骨粗隆间骨折患者术后隐性失血与抗凝的临床观察 　聂升波 沈向阳 汤继磊 　　（江苏省启东市人民医院骨二科 江苏 启东 226200） 　　【摘要】 目的：观察老年股骨粗隆间骨折患者术后隐形失血与抗凝的关系。方法：选取老年股骨粗隆间骨折病例82例，均由同一组医师采用股骨近端抗旋髓内钉（PFNA）内固定，术后结合患者的自主选择应用抗凝药物，其中低分子肝素钙35例（低分子肝素钙组），利伐沙班片21例（利伐沙班片组）华法林钠26例（华法林钠组），采集患者基本信息及术前、后血细胞比容（HCT）,并应用Gross方程计算出患者术后总失血量及隐性失血量。结果：三组患者在体重、手术时间、切口长度三方面的差异无统计学意义（P＞0.05）；三组患者术后隐形出血量，低分子肝素钙组隐性失血量401.14plusmn;20.85ml;利伐沙班片组隐性失血量(402.24plusmn;24.91)ml;华法林钠组隐性失血量400.27plusmn;25.56ml。比较三组患者隐形失血量之间的差异无统计学意义（P＞0.05）。结论：1.老年股骨粗隆间骨折患者术后存在大量隐形失血，其中隐形失血量估计可达显性失血量的4～5倍。2.患者术后应用低分子肝素钙、利伐沙班片、华法林钠三种不同抗凝药物在隐性失血方面未见明显差异。 　　【关键词】 股骨粗隆间骨折；隐性失血；低分子肝素钙；华法林钠；利伐沙班片 　　【中图分类号】R68 【文献标识码】A 【文章编号】2095-1752（2016）04-0047-02 　　In elderly patients with femoral intertrochanteric fracture clinical observation of recessive bleeding and postoperative anticoagulation 　　Nie ShengBo, Shen Xiangyang, Tang Jilei. Peoples Hospital of Qidong City, Jiangsu Province, Qidong 226200, China 　　【Abstract】Objective Observed in elderly patients with femoral intertrochanteric fractures hidden blood loss and postoperative anticoagulation. Methods Selected cases, 82 cases of femoral intertrochanteric fracture, all by the same group of physicians use proximal femur and rotary intramedullary nailing (PFNA) internal fixation, postoperative patients with combined with independent choice of the application of anticoagulant drugs, including low molecular heparin calcium 35 cases (low molecular heparin calcium group), the Bavarian shaaban piece of 21 cases (the laval shaaban group) 26 cases of warfarin sodium (warfarin sodium group). Results Three groups of patients with postoperative hidden blood loss, low molecular heparin calcium group of hidden blood loss; The laval shaaban group of hidden blood loss; Warfarin sodium group of hidden blood loss; There was no statistically significant difference (P gt; 0.05). Conclusions Postoperative application of low molecular heparin calcium, cutting class, warfarin sodium, three differe