不同部位的骨折对老年骨折患者围手术期凝血功能的影响

发布时间：2018-04-27 02:08

本文选题：老年骨折 + 围手术期　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的：探讨老年患者不同部位骨折围手术期凝血功能的影响及其术后深静脉血栓发生率的变化。方法：选取2010年7月-2013年1月治疗的60例老年骨折患者，分别为髋部骨折20例(A组)，膝关节以远骨折20例(B组)，上肢骨折20例(C组)，各组分别于麻醉前(T1)、麻醉生效后即刻(T2)、术中(T3)、术毕即刻(T4)、术后6小时(T5)，空腹采集静脉血，测定凝血酶原时间(Prothrombin time，PT)、活化部分凝血活酶时间(Activated partial thromboplastin time，APTT)、纤维蛋白原(Fibrinogen，Fib)、凝血酶时间(Thrombin time，TT)、血小板计数(PLT)及血细胞比容(HCT)水平的变化。结果：(1)3组患者PLT从麻醉开始到术毕即刻呈显著下降趋势，术后六小时又升高。其中，A组PLT与T1相比，T2、T3、T4均呈下降趋势，但至T5时，又有增高趋势，经统计学分析差异无统计学意义（F=0.567，P=0.687）。C组和B组的变化趋势相同，B组T2、T3、T4、T5和T1相比，显著下降，经LSD检验差异均有统计学意义（P值分别为0.042、0.003、0.002、0.013），C组T3、T4和T1相比，显著下降（P值分别0.037、0.006）。T5与T4相比，显著升高，且差异有统计学意义（P=0.039）。不同部位骨折患者在T1、T2、T3、T4、T5点时，PLT含量差异均无统计学意义（F值分别为0.791、0.391、0.031、0.043和0.456，P值分别为：0.458、0.678、0.969、0.957和0.636）。 (2)A组患者T2、T3、T4与T1相比，HCT显著下降，且差异有统计学意义（P值分别为0.03、0.02、0.01），B组患者T3、T4、T5与T1相比，显著下降(P值分别为0.025、0.02、0.05)，C组患者T2、T3、T4、T5与T1相比，HCT显著下降（P值分别为0.000、0.000、0.000、0.007）。同一时间点不同部位骨折患者比较T5时间点C组和A组、B组相比有显著性差异（P值分别为0.003、0.002）。 (3)PT的变化:三组患者在T1、T2、T3、T4、T5时间点的PT差异无统计学意义（F值分别为0.976、1.853、0.379、0.429、0.297，P0.05）；A组T2与T1相比，PT显著延长，且差异有统计学意义（P=0.009），B组T4、和T1相比，时间显著延长(P=0.013)，C组T2、T4、T5和T1相比时间显著延长（P值分别为0.007、0.021、0.036）。 (4)APTT的变化:A组和B组在不同时间点APTT水平差异无统计学意义（F=0.102、0.314，P0.05），C组T5和T1相比，APTT显著延长(P=0.021);A、B和C组患者在T1、T2、T3、T4时间点APTT比较，差异无统计学意义(F值分别为0.698、0.317、0.041、0.294，P0.05)，在T5时，C组与B和A组相比，APTT显著延长(P=0.019和0.037)。 (5)FIB的变化:三组患者FIB水平从麻醉开始到术毕即刻呈显著下降趋势。其中，A组T4和T1相比，FIB显著下降（P=0.027），T5和T4相比明显升高（P=0.030）。B组T2、T3、T4、T5和T1相比显著下降(P值分别为0.009、0.000、0.000、0.002)，C组T3、T4和T1相比显著下降（P=0.015、0.002）。3组患者在T1时间点FIB差异无统计学意义（F=2.108，P0.05），T2时间点，C组与A组相比，差异有统计学意义(P=0.027)，T3时间点，差异无统计学意义(F=1.157，P0.05)，T4时间点C组与A组相比，差异有统计学意义(P=0.046)，T5时间点C组和A组、B组相比有显著性差异（P=0.046、0.020），C组值明显低于其它两组，A组值高于B组。 (6)TT的变化:A组T4、T5和T1相比，显著下降（P=0.016、0.033），B和C组各时间段差异无统计学意义（F=1.079和0.895，P0.05），但两组患者术毕或术毕即刻值比术前缩短。T1、T2、T3、T4时间点三组患者TT差异均无统计学意义(F=2.891、0.874、0.435、2.031，P0.05)，，T5时间点，C组与B组和A组相比，差异有统计学意义(P=0.035和0.016)。结论：1、老年患者膝关节以远及上肢骨折围术期血液高凝状态较髋部骨折患者低；2、老年患者上肢骨折围术期血液的高凝状态较下肢骨折患者轻。
[Abstract]:Objective : To investigate the effect of perioperative coagulation and the changes of postoperative deep vein thrombosis in elderly patients .

Methods : 60 elderly patients with fracture of hip fracture were selected from July 2010 to January 2013 , including 20 cases of hip fracture ( group A ) , 20 cases of knee joint distal fracture ( group B ) and 20 cases of upper limb fracture ( group C ) . The changes of prothrombin time ( PT ) , activated partial prothrombin time ( PT ) , fibrinogen ( PLT ) and hematocrit ( HCT ) were measured .

Results : ( 1 ) PLT decreased significantly from anesthesia to immediate after operation , and increased in 6 hours after operation . Among them , PLT and T1 decreased in group A , but there was an increase in T _ 2 , T _ 3 and T _ 4 in group A , but there was no significant difference in the statistical analysis ( F = 0.567 , P = 0.687 ) . Compared with T _ 4 , T _ 3 , T _ 3 , T _ 4 , T _ 4 , T _ 4 , T _ 3 , T _ 3 , T _ 4 , T _ 4 , T _ 4 , T _ 3 , T _ 3 , T _ 4 , T _ 4 , T _ 4 , T _ 3 , T _ 3 , T _ 4 , T _ 4 , T _ 4 , T _ 4 , T _ 3 , T _ 3 , T _ 4 , T _ 4 and T _ 4 were significantly lower ( P = 0.039 ) .

Compared with T1 in group A , there was a significant decrease in HCT ( P = 0 . 025 , 0 . 02 , 0 . 05 ) and T _ 2 , T _ 3 , T _ 4 , T _ 5 and T _ 1 in group C were significantly decreased ( P < 0 . 0 . 0 . 0 . 000 , 0 . 000 , 0.007 ) .

( 3 ) PT : There was no significant difference in PT between three groups ( 0.976 , 1.853 , 0.379 , 0.429 , 0.297 , P0.05 ) .
Compared with T1 , T2 , T4 , T5 and T1 in group A were significantly prolonged ( P = 0 . 013 ) , T _ 2 , T _ 2 , T _ 4 , T5 and T1 were significantly prolonged ( P = 0.007 , 0.021 , 0.036 ) .

( 4 ) There was no significant difference ( F = 0 . 102 , 0 . 314 , P 0 . 05 ) between group A and group B at different time points ( F = 0 . 102 , 0 . 314 , P 0 . 05 ) .

Compared with group A , there was no significant difference between group A ( P = 0.027 ) , T 3 , T 4 , T 5 and T 1 ( P = 0.047 , P < 0 . 002 ) . Compared with group A , there was significant difference between group C and group A ( P = 0.046 , P < 0 . 020 ) , and C group was significantly lower than that in group A and group B ( P = 0.046 , 0.020 ) .

( 6 ) TT : Compared with group A T4 , T5 and T1 , there was no significant difference between the two groups ( F = 1.079 and 0.895 , P0.05 ) , but there was no significant difference between the two groups ( F = 2.891 , 0.874 , 0.435 , 2.031 , P0.05 ) .

Conclusion : 1 . The high blood coagulation state of knee joint in elderly patients is lower than that in hip fracture patients .
2 . The high - coagulation state of the blood during the perioperative period of the upper limb fracture of the elderly patient is less than that of the lower limb fracture patients .

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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