低分子肝素钙联合银杏达莫注射液应用于股骨粗隆间骨折术后下肢深静脉血栓形成的疗效观察

目的:探讨低分子肝素钙联合银杏达莫注射液应用于股骨粗隆间骨折术后下肢深静脉血栓形成的治疗效果。方法:选择2015年6月至2016年12月间我院骨科收治的股骨粗隆间骨折的患者80例,按随机数字表法分为研究组和对照组,每组各40例。两组患者均接受手术治疗,对照组术后应用低分子肝素钙6000IU治疗,皮下注射,2次/d;研究组在此基础上应用银杏达莫注射液20 m L治疗,静脉滴注,1次/d,疗程均为10 d。观察两组患者术后下肢深静脉血栓发生率、髌骨上极上15 cm周径、髌骨下极下15 cm周径及肿胀率,治疗前后凝血酶原时间(PT)、活化部分凝血活酶时间(APPT)、D-2聚体(D-D)水平和血液流变学检查指标。结果:治疗期间研究组下肢深静脉血栓发生率为2.50%,显著低于对照组的15.00%(P0.05)。治疗后两组患者髌骨上极上15cm周径、髌骨下极下15 cm周径均轻微增高,与治疗前比较无统计学差异(P0.05)。两组患者髌骨上极上15 cm肿胀率、髌骨下极下15 cm肿胀率比较无统计学差异(P0.05)。治疗后2d研究组患者PT、APPT显著高于对照组,D-D显著低于对照组(P0.05),治疗后10 d研究组PT、APPT显著高于对照组,D-D显著低于对照组(P0.05)。治疗后2 d、治疗后10 d研究组全血低切、全血高切、血浆黏度、红细胞压积、红细胞聚集指数和纤维蛋白原显著低于对照组(P0.05)。结论:低分子肝素钙联合银杏达莫注射液可以降低血液凝固性,改善血液流变学,对预防股骨粗隆间骨折下肢深静脉血栓形成有良好的疗效。

Curative Effect Observation of Low Molecular Weight Heparin Calcium Combined with Ginkgo Leaf Extract and Dipyridamole Injection in the Treatment of Femoral Intertrochanteric Fractures of Lower Extremity Deep Vein Thrombosis after Surgery

ABSTRACT Objective: To investigate the treatment effect of low molecular weight heparin calcium combined with Ginkgo Leaf Extract and Dipyridamole Injection on the lower extremity deep femoral intertrochanteric fracture postoperative venous thrombosis treatment. Methods: Selected 80 patients with femoral intertrochanteric fractures at department of orthopedics in our hospital from June 2015 to December 2016, which were randomly divided into study group (n=40) and control group (n=40) according to the random number table method. Patients of two groups were treated with surgical treatment. The control group was treated with low molecular weight heparin calcium 6000IU after surgery, subcutaneous injection, 2 times /d; The study group were treated with Ginkgo Leaf Extract and Dipyridamole Injection 20 mL on the basis of the control group, intravenous drip, 1 time /d, and the course of treatment in two groups was 10d.Observed incidence of lower extremity deep venous thrombosis, the 15 cm diameter and the swelling rate of the upper pole of the patella and the inferior pole of the patella of patients in two groups after surgery, the prothrombin time (PT), activated partial thromboplastin time (APPT), D-dimer (D-D) levels and blood rheology examination index before and after treatment. Results: The incidence of lower extremity deep venous thrombosis in the study group was 2.50%, which was lower than that 15.00% in the control group (P<0.05). After treatment, 15 cm diameter of the superior pole of the patella and the 15cm diameter of the inferior pole of the patella of patients in two groups were increased slightly, and there was no statistical difference compared with before treatment (P>0.05). There was no significant difference between the two groups in the swelling rate of 15 cm on the upper pole of the patella and 15 cm in the inferior pole of the patella (P>0.05). PT and APPT of patients in the study group were significantly higher than the control group at 2 d after treatment, and D-D was significantly lower than the control group (P<0.05). At 10d after treatment, APPT and PT were significantly higher than the control group, D-D was significantly lower than the control group (P<0.05). At 2d, 10d after treatment, the whole blood high and low shear blood plasma viscosity, hematocrit, erythrocyte aggregation index and fibrinogen in study group were significantly lower than the control group (P<0.05). Conclusion: Low molecular weight heparin calcium combined with Ginkgo Leaf Extract and Dipyridamole Injection can reduce blood coagulation, improve blood rheology, which has a good effect on prevention of deep vein thrombosis of lower extremity in patients with femoral intertrochanteric fractures.