老年患者骨折围手术期深静脉血栓防治的临床研究

发布时间：2018-01-20 13:22

本文关键词： 老年骨折深静脉血栓小腿肌间静脉血栓利伐沙班低分子肝素　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:随着老龄化步伐的加快,我国老年人口日趋庞大,由于身体机能衰退,反应能力迟缓,同时老年人多伴有骨质疏,轻微的外力就可以导致骨折。深静脉血栓是老年骨折患者常见的并发症,严重影响患者生活质量,严重者威胁生命。在老年骨折患者围手术期进行深静脉血栓的预防和治疗具有重要临床意义。方法:选取我科200例老年骨折患者病例,探索骨折部位、年龄、手术时间、Caprini评分、合并症、以及利伐沙班和低分子肝素在老年骨折患者围手术期深静脉血栓形成过程中的预防和治疗效果评估。结果:1:年龄:本研究将老年骨折患者分为2组,一组为65-74岁之间,一组为75岁及以上。统计分析显示75岁以上骨折患者形成小腿肌间静脉血栓的概率更高。2:患病部位:老年骨折患者骨折部位大部分为髋部骨折,骨盆骨折次之,二者形成肌间静脉血栓的概率更高。3:Caprini评分:由于患者年龄大,同时伴有并发症,所以大部分患者Caprini评分都在3分以上,均属于中高危险人群,建议给予物理、药物预防和治疗。4:合并症:伴有糖尿病、高血压、冠心病老年骨折发生深静脉血栓概率比无合并症患者高,建议围手术期进行物理、药物预防和治疗。5:手术时间:手术时间大于3小时患者患小腿肌间静脉血栓的风险性更大,手术最好在尽可能短的时间内完成。6:治疗药物:本研究比较了低分子肝素和利伐沙班治疗小腿肌间静脉血栓的效果和安全性,结果显示二者均有效治疗小腿肌间静脉血栓,且能阻止其向DVT发展,但是利伐沙班治疗效果略好于低分子肝素,且无并发症发生。利伐沙班且具有良好的用药安全性,值得在临床推广。结论:老年患者围手术期应综合患者年龄、合并症、骨折部位、Caprini评分等因素给予物理预防和药物治疗,利伐沙班在小腿肌间静脉血栓的治疗中预后较好、且更具安全性。
[Abstract]:Objective: with the accelerated pace of aging, China's elderly population is growing larger, due to the decline of physical function, slow response, and the elderly more accompanied by bone thinning. Deep venous thrombosis (DVT) is a common complication in elderly patients with fractures, which seriously affects the quality of life of patients. It is very important to prevent and treat deep venous thrombosis in the perioperative period of senile fracture patients. Methods: 200 cases of senile fracture patients in our department were selected to explore the fracture site. Age, operative time, Caprini score, complications. Evaluation of the prevention and treatment effect of Levasaban and low-molecular-weight heparin in perioperative deep venous thrombosis in elderly patients with fracture. Results: 1: age: this study divided the elderly patients into two groups. One group was between 65 and 74 years old. One group was 75 years old and over. Statistical analysis showed that patients over 75 years of age had a higher probability of developing intermuscular vein thrombosis in the leg. 2. The location of the disease: the fracture site of the elderly fracture patients was mostly hip fracture. Pelvic fractures followed, with a higher probability of intramuscular venous thrombosis. 3: Caprini score: because of the age of the patient, accompanied by complications. So most patients with Caprini score above 3, all belong to the high risk group, recommended to physical, drug prevention and treatment .4: complications: accompanied by diabetes, hypertension. The incidence of deep venous thrombosis in elderly patients with coronary heart disease is higher than that in patients without complications. Perioperative physical therapy is recommended. Drug prophylaxis and treatment .5: operative time: patients with more than 3 hours of surgery have a greater risk of developing intermuscular vein thrombosis in the leg. Surgery is best done in as short a time as possible. 6: therapeutic drugs: this study compared the efficacy and safety of low-molecular-weight heparin and rivastaban in the treatment of intermuscular vein thrombosis in the leg. The results showed that both of them were effective in the treatment of intermuscular vein thrombosis of the leg and could prevent the development of DVT, but the effect of livasaban was slightly better than that of low molecular weight heparin (LMWH). There are no complications. Rivastaban has good drug safety, it is worth popularizing in clinic. Conclusion: the elderly patients should synthesize the patient's age, complication and fracture site in perioperative period. Caprini score and other factors were given physical prevention and drug therapy. Rivastaban had a better prognosis and more safety in the treatment of intermuscular vein thrombosis of the leg.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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