超高龄患者填充骨水泥型人工股骨头置换术后的凝血功能变化及意义

目的：观察骨水泥填充对人工股骨头置换术术后超高龄老年患者凝血系统的影响。方法：选择80岁以上骨水泥型人工股骨头置换术患者29例,于术前、术后当天及术后第3天空腹抽取静脉血,测定凝血功能相关指标,包括凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原活动度（PTA）、国际标准化比值（INR）、纤维蛋白原（FIB）、D二聚体（DD）、抗凝血酶Ⅲ（ATⅢ）、血小板（PLT）水平,并对结果进行比较分析。结果：患者术后当天FIB、DD、显著升高（P〈0.05）,ATⅢ降低（P〈0.05）,提示高凝状态,且纤溶亢进,此时段TT、PT延长（P〈0.05）,血小板明显降低,提示存在出血风险;术后第3天TT、PT显著延长（P〈0.05）,ATⅢ恢复到术前水平,FIB,DD水平较手术后当天下降,提示术后第3天有明显的出血倾向,凝血与纤溶系统逐渐恢复平衡。结论：骨水泥型人工股骨头置换术对80岁以上超高龄患者凝血功能有显著影响,术后当天高凝状态、纤溶亢进,存在潜在出血风险,术后第3天有明显出血倾向,提示高龄患者术后应适当补充凝血因子且须谨慎使用抗凝药物。

Coagulation Changes of Very Elderly Patients after Cemented Artificial Femoral Head Replacement

Objective： To observe and analyze the changes of blood coagulation function of very elderly patients with cemented artificial femoral head replacement during perioperative period.Methods： A total of 29 cases with cemented artificial femoral head replacement were retrospectively analyzed.Several parameters were analyzed preoperative,postoperative day,3 days after the operation.These included the number of platelet（PLT）,prothrombin time（PT）,activatedpartial thromboplastin time（APTT）,Prothrombin activity（PTA）,fibrinogen（Fib）,international normalized ratio（INR） and thrombin time（TT）,D-dimer（DD）,antithrombinⅢ（ATⅢ）.Results： Compared with the values recorded before operation,the FIB and DD were elevated,while ATⅢ was lowered（P0.05） in postoperative day,which suggested hypercoagulable state and hyperfibrinolysis,and in this period TT,PT prolonged significantly（P0.05）,platelets decreased,which suggested that there was risk of bleeding.In the 3rd postoperative day the level of TT,PT was significantly prolonged（P0.05）,ATⅢ returned to preoperative levels,FIB,DD levels decreased over the day after surgery,which showed that there was a tendency of bleeding inthe postoperative 3 day,the coagulation and fibrinolysis function were recovering gradually.Conclusion： It affected significantly the blood coagulation that the operation of cemented artificial femoral head replacement of very elderly patients aged over 80 years.The very elderly patients should be added coagulation factors appropriately and careful of using anticoagulant drugs.