The Detect Of Prethrombotic State In Senile Patients With Hip Fracture And The Prevention Of Deep Vein Thrombosis

Venous thromboembolism(VTE) is composed of deep vein thrombosis (DVT) and pulmonary embolism(PE).Venous thromboembolism occurs more often in lower extremities, Such as deep vein, femoral vein calf, for the most common is iliac vein。Cause the disease risk factors have heart disease, cancer, trauma, operation, pregnancy, obesity, aged, prolonged bed and drugs, but the most closely related factor is the surgery of lower limbs.Early symptoms of VTE are oftennot easily found. When deep vein thrombosis happened, complications of thrombolysis drug and suegery are so much. So,the prevention of VTE in perioperative period put emphasis on detection and prevention of previous stateof thrombus.TCM has a long history, the ancient medical books though not record DVT happens when after a total hip surgery, but have relevant described in " Pulse bi-complex ", " Strands of swollen," " Blood stasis lingers "etc. The total pathological mechanism is stasis resistance contexts, qi-blood stagnation. Current research proof that Chinese traditional medicine or proprietary Chinese medicine have certain curative effect in prevention and treatment of deep vein thrombosis.Objective:This study choose senile patients with hip fracture who defined as in the state of previous thrombus as research object in the second orthopaedic of Guangdong hospital of traditional Chinese medicine. The patients were divided into two groups, one is used dengzhanhua injection before surgery and the other is used fraxiparine after surgery. Then compare the differences effects bettween the two treatment.This paper discusses the efficacy and safety, the advantages and disadvantages of the two treatment, looking for effective preventive measures to keep from forming vein thrombosissenile in perioperative period of senile patients with hip fracture.MethodsAfter randomly grouped the patients who complies with the standards into two group, measure the data of the D-seventh dimer (D-D), wd factor antigen (vWF:Ag), platelet alpha particle membrane protein-140 (GMP-140), thrombin time (APTT), fibrinogen (Fib) etc, and record the data of peri-operative bleeding and postoperative lead flow of blood transfusions and limb swelling.Then using this data to establish database and analyzed in statistics.ResultsIn the study, patients who considered in the state of previous thrombus were applied dengzhanhua injection to prevent forming deep vein thrombosis lower extremities,18 cases, blood clots in 1 case, thrombus incidence is 5.56%; The control group using fraxiparine to prevent forming deep vein thrombosis lower extremities, blood clot in 1 case, thrombus incidence is 5.00%. The two group have non-significance difference, this shows that used dengzhanhua injection before surgery and used fraxiparine after surgery have the sane effect.As to senile patients with hip fracture in perioperative period, there are still significant differences between used dengzhanhua injection before surgery and used fraxiparine six hours after surgery in complications and side effect.Conclusion1. Patients who considered in the state of previous thrombus before surgery were applied dengzhanhua injection immediately, the peri-operative bleeding and postoperative lead flow, the amount of postoperative blood transfusion of the two groups have not obviously increase,so this comparison have no significant difference. But the lead flow of two patients of the group of used fraxiparine is more than 500ml, when used fraxiparine advance, the testing index of the two patients have no diferences from other patients. So, though the patient's past medical history does not have hemorrhagic disease, when used fraxiparine after surgery, we should identify hemorrhagic disease to prevent side effects of bleeding. 2. Before surgery and at 7 days postoperatively,the FiB, D dimers, FDP, plasma protein C, AT-3 and hemorheology of whole blood viscosity, whole blood viscosity, RBC reduction deposited of the two groups of post-operation are better than pre-operation. Through the statistical test, the data of pre-operation and post-operation of the two groups have significant differences. Dengzhanhua injection has the role of invigorate the efficacy of dredging, acetanilide detumescence, dilate of blood vessels, improve microcirculation, promote fibrinolytic antithromboric and the lower of plasma fibrinogen.3. As to the comparision of the lower limb weeks diameter of the two groups, the turgidity rate of patellar above,patellar below and above NaHuai have no significant differences. The detumescence rate of above NaHuai of the fraxiparine is better than dengzhanhua injection. This shows that fraxiparine better play in detumescence have relation with single component and definite effect.4. Two groups of patients of study meet the stand of in the state of previous thrombus, though most of the testing index of them are decreased to different extent, but higher than normal reference value range. Therefore, the two groups of patients are still in thrombosis former state at 7 days postoperatively, and still needs a strong attention to defend deep vein thrombosis after 1 week.5. This research study the risk factors of DVT, due to the limited number of samples, two groups of patients fail to do statistics processing, but still can reflect the DVT epideminlogical trend of senile patients with hip fracture in perioperative. On hemorheology, coagulation, anticoagulation, fibrinolytic and detumescence rate of lower limbs in the statistical analysis, patients who considered in the state of previous thrombus were applied dengzhanhua injection immediately can lower blood high viscosity and high pour-point state, promote the lower limb blood circulation effectively and remove blood stasis detumescence, blocking the risk factors of forming DVT, thus reduce the incidence of DVT, and of little side effects.