血栓弹力图在老年全髋置换术后抗凝的价值△

Significance of thromboelastography used in anticoagulation after total hip arthroplasty in the elderly

摘要:

［目的］ 探讨血栓弹力图在老年全髋置换围术期的应用。［方法］ 选择 2018 年 5 月—2020 年 12 月长沙市中心医院收治的全髋关节置换术患者 200 例。按随机数字表法分为两组，各 100 例。固定组术后 6 h 常规使用低分子肝素钙，动态组根据术后 6 h 血栓弹力图结果实施抗凝治疗。观察术后血栓发生情况，比较两组血栓弹力图检测结果，ROC 分析血栓弹力图预测血栓发生情况。［结果］两组患者手术时间、切口长度、术中失血量、术后引流量、切口愈合及血栓发生时间的比较差异均无统计学意义（P>0.05），动态组术后总住院时间少于固定组（P<0.05），术后行走时间早于固定组（P<0.05），固定组的血栓发生率显著高于动态组（P<0.05）。动态组术后 24 d 时和术后 48 d 时，血栓弹力图 R 值和 K 值大于固定组（P<0.05），MA 值、An- gle-α 值及 CI 值小于固定组 （P<0.05）。血栓弹力图指标中 K 值预测血栓发生灵敏度 （80.0%） 和特异度 （99.5%） 均最高， AUC=0.924。［结论］ 血栓弹力图指导全髋置换术患者术后抗凝，能有效调节凝血因子及血小板功能，减少术后下肢深静脉血栓发生率，提高手术安全性。

Abstract:

[Objective] To evaluate the significance of thromboelastography used in anticoagulation during perioperative period of total hip arthroplasty in the elderly. [Methods] A total of 200 patients who were undergoing total hip arthroplasty in Changsha Central Hospital from May 2018 to December 2020 were enrolled into this study. According to random number table method, they were divided into two groups. Of them, 100 patients were routinely given low-molecular-weight heparin calcium at a fixed program 6 hours after surgery (the fixed group), whereas the remaining 100 patients received anticoagulant therapy based on the results of thromboelastography 6 hours after surgery dynamically (the dynamic group) . The occurrence of postoperative thrombosis was observed, and the results of thromboelastography were compared between the two groups. The parameters of thromboelastography were analyzed by ROC to predict the occurrence of thrombo- sis. [Results] There were no significant differences in operative time, incision length, intraoperative blood loss, postoperative drainage vol- ume, incision healing and time of thrombosis between the two groups (P＜0.05) . However, the dynamic group proved significantly superior to the fixed group in terms of total hospital stay and time to return walking postoperatively (P＜0.05) , additionally, the dynamic group had significantly lower incidence of thrombosis than the fixed group (P＜0.05) . At 24 and 48 days postoperatively, the dynamic group had signifi- cantly higher R and K values, whereas significantly lower MA, Angle-α and CI values than the fixed group (P＜0.05) . As results of ROC analysis, the K value had the highest sensitivity (80.0%) and specificity (99.5%) for predicting thrombogenesis, with AUC=0.924. [Conclusion] Thromboelastography do guide postoperative anticoagulation that effectively regulate coagulation factors and platelet function, reduce the incidence of postoperative lower extremity deep vein thrombosis, and improve surgical safety in total hip arthroplasty.