| Objective: In the past few years, with the aging of population, the incidence of hip fracture has a tendency to increase. Due to the cause of age trauma, immobilization etc, elderly patients has a higher incidence of lower limb venous thrombosis after fracture. Owing to the high incidence and severe clinical consequences, Prevention of deep vein thrombosis for orthopaedic patients is particularly important. At present, there are two main preventive measures to decrease the rate of DVT:Mechanical method and drugs. The first method is to promote venous blood backflow by mechanical device so as to increase the blood flow velocity, reduce blood pooling, thereby reducing the occurrence of thrombosis. Commonly used installation is stretch hose and vein pump device. Its advantage is of no increased risk of bleeding, but the application is limited in trauma patients, and its efficacy is unreliable. The prevention medicines commonly used are including aspirin, heparin, low molecular weight heparin etc. Aspirin can reduce platelet aggregation and reduce the incidence of thrombosis, but not as a regular medication. Because of the need to closely observe patient’s blood coagulation function, and the medical complications such as the risk of bleeding, anaphylactic reaction,heparin application is limited. The most widely used drug is low molecular heparin. Low molecular heparin calcium is a new type of antithrombin Ⅲdependence of antithrombotic drugs. It has obvious anticoagulant factor Xa activity and weak activity of Anti-clotting factors Ⅱa or antithrombin. Low molecular heparin can inhibit the formation of arteriovenous thrombosis, but does not affect the combination of platelet aggregation. It also has no influence on the combination of fibrinogen and platelet. When it plays a role of antithrombotic, the dangerous of bleeding is lower. Low molecular heparincan stimulate the endothelial cells to release tissue factor coagulation pathway inhibitor and fibrinolytic enzyme activation. It will not be neutralized by the factor 4 and has no obvious effect on platelet function as well;it has indirect synergy for thrombolysis and used for curing deep vein thrombosis that has formed.Therefore the low molecular heparin is widely promoted by orthopedic surgeons. However, there is no consistent opinion on the application methods of low molecular heparin. Every application method has its supporters and most researches are occupied by postoperative anticoagulant solutions. There were few reports about preoperative anticoagulant solution and effect on body’s blood.So this research will divide the patients into two groups by the method of prospective study method : group A adopts hypodermic injection of 5000 IU low molecular weight heparin, once a day;group B adopts hypodermic injection of 5000 IU low molecular weight heparin,twice a day. Then compare group A with group B on their prevention effect,blood loss during surgery and complication rate. Thus to analysis the therapeutic effect and to provide theoretical basis for clinical application.Method: Divide the 65 patients to two groups, which were suffered from femoral intertrochanteric fracture and saw a doctor and hospitalized in Cangzhou hospital of integrated Chinese and western medicine during May2014 to September 2015.Inclusion criteria:1, All patients are low-energy injured caused by tumble.There is no fracture from other body parts and no open wounds.2,Older than60 years of age; 3, After hospital admission, DVT appears negative when immediately examined by color doppler ultrasound. 4, No thromboembolic disease history.Exclusion criteria:1, Medium and severe liver and kidney impairment. 2,Coagulation disorders.3, Patients of hemorrhagic disease history recently. 4,Allergic to low molecular heparin ingredient. 5, Ppeptic ulcer. 6,Bacterial endocarditis. 7,Refused to participate. group A adopts hypodermic injection of5000 IU low molecular weight heparin, once a day; group B adopts hypodermic injection of 5000 IU low molecular weight heparin, twice a day.All patients were performed surgical treatment and adopt the method of intraspinal anesthesia. Stop using the low molecular heparin calcium 12 hours before the surgery. Both group A and B patients were treated with the method of proximal femoral intramedullary nail fixed and placed drainage tube after surgery. In addition, record the volume of drainage and prevent patient from DVT according to the preoperative anticoagulant solution during the 12-hour postoperation. Recheck the routine blood and observe changes of hemoglobin after three days,. After a week, make an examination of the vein of lower limbs of color doppler ultrasound to understand if there is thrombus.Results: All patients have no symptomatic DVT in a week after the surgery. In group A, 5 cases got plexus venosus leg muscle thrombosis. The occurrence rate is 15.6%. In group B, 3 cases got plexus venosus leg muscle thrombosis. The occurrence rate is 9.1%. In the two groups, there is no statistically significant difference of DVT incidence(X2=0.642,P=0.422).The two groups’ blood routine results re-examination after 3 days of the surgery show dramatic hemoglobin decline. The difference is statistically significant.However, Hemoglobin levels change in patients between the two groups is not statistically significant. None of the patients has the complication of digestive tract bleeding, hematoma, increased wound ooze blood,epidural hematoma etc.The average volume of drainage postoperation of the two groups are(250.8±71.7)and(269.5±60.3)m L respectively,which of no statistical signifi-cance(t=0.166,P=0.835).Conclusion: This research shows that there are no visible difference of blood loss post-surgery between routine low molecular heparin dose subcutaneous injection once a day and twice a day, and that stop using 12 hours before surgery, continue to use 12 hours after surgery. For preventing effect, both groups have no symptomatic DVT. Hypodermic injection twice a day makes a lower incidence of VTE which has no statistical differences.Therefore, clinical application should base on the degree of patient’s blood clots risk to appropriately adjust application frequency. |
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