糖尿病患者與空腹血糖水平正常患者TKA術(shù)后早期凝血狀態(tài)變化趨勢及臨床意義
發(fā)布時(shí)間：2018-11-23 09:09
【摘要】：目的觀察并比較糖尿病合并膝骨關(guān)節(jié)炎病人及空腹血糖水平正常病人在初次行單側(cè)人工膝關(guān)節(jié)表面置換術(shù)后血清中凝血酶原時(shí)間(PT)、活化部分凝血活酶時(shí)間(APTT)、凝血酶時(shí)間(TT)、纖維蛋白原(FIB)、以及血小板計(jì)數(shù)(PLT)等的變化趨勢及其臨床意義。方法研究對象選取2014年12月至2016年12月在廣州市第一人民醫(yī)院診斷為骨性關(guān)節(jié)炎,并初次行單側(cè)TKA手術(shù)的所有患者,入院時(shí)檢測空腹血糖水平,根據(jù)空腹血糖水平及病史情況,將患者分為兩組:糖尿病患者組及空腹血糖正常組(正常人組)。糖尿病組入組患者總數(shù)為30例,年齡范圍在60-85歲之間,其中女性25例,男性5例;同一時(shí)期行初次TKA手術(shù),無合并糖尿病的患者中選取與糖尿病組患者年齡、性別相對應(yīng)或相符的30例患者作為正常人組,年齡范圍在60-85歲之間,其中女性26例,男性4例。兩組中所有觀察對象除糖尿病組患者行控制血糖水平治療等措施以外,于圍手術(shù)期給予相同的臨床干預(yù)、治療。兩組分別于術(shù)前、術(shù)后第1天、第3天,第7天清晨空腹采集肘前靜脈血液標(biāo)本,檢測凝血酶原時(shí)間(PT)、活化部分凝血活酶時(shí)間(APTT)、凝血酶時(shí)間(TT)、纖維蛋白原(FIB)、以及血小板計(jì)數(shù)(PLT)等指標(biāo)的變化。并通過對其變化趨勢的分析,反映出其所表達(dá)的臨床意義等情況。結(jié)果1.兩組患者術(shù)后血液中FIB含量變化的趨勢均為術(shù)后第1天開始升高,在術(shù)后第3天時(shí)達(dá)到峰值(糖尿病組=5.25g/L,正常人組=4.44g/L),雖然術(shù)后第7天較術(shù)后第3天有所下降,但較術(shù)前水平仍有上升,而且糖尿病組患者血液中FIB指標(biāo)在術(shù)后各個(gè)時(shí)間點(diǎn)較正常人組都偏高,有統(tǒng)計(jì)學(xué)差異。2.兩組患者血液中PLT計(jì)數(shù)的變化趨勢基本一致,術(shù)后第1天較術(shù)前有明顯下降,術(shù)后第3天下降到最低值(糖尿病組=203.60*109/L,正常人組209.80*109/L),到術(shù)后第7天時(shí)兩組患者血液中的血小板水平恢復(fù)到術(shù)前水平。而兩組患者在各時(shí)間點(diǎn)上的PLT計(jì)數(shù)沒有統(tǒng)計(jì)學(xué)差異。3.兩組患者的TT,APTT,PT值進(jìn)行統(tǒng)計(jì)學(xué)分析比較,兩組患者的這三組數(shù)據(jù)無論術(shù)前還是術(shù)后不同的時(shí)間點(diǎn)比較,均沒有統(tǒng)計(jì)學(xué)差異。而這三組數(shù)據(jù)在各個(gè)組內(nèi)不同時(shí)間點(diǎn)比較,除糖尿病組術(shù)前與術(shù)后第1天的TT值,APTT值有統(tǒng)計(jì)學(xué)差異外,其余的組內(nèi)比較均無統(tǒng)計(jì)學(xué)意義。此三組指標(biāo)術(shù)后無明顯變化趨勢,均在正常范圍內(nèi)波動(dòng)。結(jié)論1.初次單側(cè)TKA術(shù)后,膝關(guān)節(jié)骨關(guān)節(jié)炎伴糖尿病患者血液的高凝狀態(tài)較空腹血糖正常的患者更為嚴(yán)重。2.膝關(guān)節(jié)骨關(guān)節(jié)炎患者初次單側(cè)TKA術(shù)后FIB指標(biāo)呈先升后降的變化趨勢,術(shù)后監(jiān)測FIB指標(biāo)的變化有利于對評估膝關(guān)節(jié)骨關(guān)節(jié)炎患者TKA術(shù)后的凝血狀態(tài)。
[Abstract]:Objective to observe and compare the serum prothrombin time (PT),) activation partial thromboplastin time (APTT),) in patients with diabetes mellitus complicated with knee osteoarthritis and normal fasting blood glucose level after the first unilateral artificial knee arthroplasty. Changes of thrombin time (TT), fibrinogen (FIB), and platelet count (PLT) and its clinical significance. Methods all the patients who were diagnosed as osteoarthritis from December 2014 to December 2016 in Guangzhou first people's Hospital and underwent unilateral TKA for the first time were selected and the fasting blood glucose level was measured on admission, according to the fasting blood glucose level and the history of the disease. The patients were divided into two groups: diabetic group and normal fasting blood glucose group (normal group). The total number of patients in the diabetes group was 30. The age range was between 60 and 85 years old. 25 cases were female and 5 cases were male. In the same period of initial TKA operation, 30 patients with diabetes mellitus (age, sex) were selected as normal subjects. The age ranges from 60 to 85 years old, including 26 women and 4 men. All the subjects in the two groups were given the same clinical intervention and treatment during perioperative period except diabetes patients. The blood samples of anterior elbow vein were collected before operation, 1 day, 3 days and 7 days after operation, respectively. The prothrombin time (PT),) and partial thromboplastin time (APTT),) were detected in the two groups. The thrombin time (TT),) was measured by partial thromboplastin time (APTT),). Changes of fibrinogen (FIB), and platelet count (PLT). And through the analysis of its changing trend, it reflects the clinical significance of its expression and so on. Result 1. The change trend of blood FIB content in both groups was beginning to increase on the first day after operation and reached its peak on the third day after operation (diabetes group = 5.25g / L, normal person group = 4.44g/L). Although on the 7th day after operation compared with the third day after operation, the level of blood FIB in the diabetic group was still higher than that in the normal group, and there was statistical difference between the diabetic group and the normal group at each time point. 2. The change trend of PLT in the blood of the two groups was basically the same. On the first day after operation, it was significantly lower than that before operation, and on the third day after operation, it decreased to the lowest value (diabetes group = 203.60 / 109 / L, normal group 209.80 / 109 / L). By the 7th day after operation, the platelet levels in the blood of the two groups returned to the preoperative level. There was no significant difference in PLT counts between the two groups at all time points. The TT,APTT,PT values of the two groups were statistically analyzed and compared. There was no statistical difference in the data of the three groups before and after operation. The data of the three groups were compared at different time points in each group, except for the TT value and APTT value of the diabetic group before and after the first day, there was no statistical significance in the other groups. There was no obvious change trend in these three groups after operation, and all of them fluctuated within normal range. Conclusion 1. After primary unilateral TKA, hypercoagulability in knee osteoarthritis with diabetes was more severe than that in patients with normal fasting blood glucose. 2. 2. The FIB index of knee osteoarthritis patients increased first and then decreased after primary unilateral TKA. Monitoring the changes of FIB index after operation was helpful to evaluate the coagulation status of TKA patients with knee osteoarthritis.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1
[Abstract]:Objective to observe and compare the serum prothrombin time (PT),) activation partial thromboplastin time (APTT),) in patients with diabetes mellitus complicated with knee osteoarthritis and normal fasting blood glucose level after the first unilateral artificial knee arthroplasty. Changes of thrombin time (TT), fibrinogen (FIB), and platelet count (PLT) and its clinical significance. Methods all the patients who were diagnosed as osteoarthritis from December 2014 to December 2016 in Guangzhou first people's Hospital and underwent unilateral TKA for the first time were selected and the fasting blood glucose level was measured on admission, according to the fasting blood glucose level and the history of the disease. The patients were divided into two groups: diabetic group and normal fasting blood glucose group (normal group). The total number of patients in the diabetes group was 30. The age range was between 60 and 85 years old. 25 cases were female and 5 cases were male. In the same period of initial TKA operation, 30 patients with diabetes mellitus (age, sex) were selected as normal subjects. The age ranges from 60 to 85 years old, including 26 women and 4 men. All the subjects in the two groups were given the same clinical intervention and treatment during perioperative period except diabetes patients. The blood samples of anterior elbow vein were collected before operation, 1 day, 3 days and 7 days after operation, respectively. The prothrombin time (PT),) and partial thromboplastin time (APTT),) were detected in the two groups. The thrombin time (TT),) was measured by partial thromboplastin time (APTT),). Changes of fibrinogen (FIB), and platelet count (PLT). And through the analysis of its changing trend, it reflects the clinical significance of its expression and so on. Result 1. The change trend of blood FIB content in both groups was beginning to increase on the first day after operation and reached its peak on the third day after operation (diabetes group = 5.25g / L, normal person group = 4.44g/L). Although on the 7th day after operation compared with the third day after operation, the level of blood FIB in the diabetic group was still higher than that in the normal group, and there was statistical difference between the diabetic group and the normal group at each time point. 2. The change trend of PLT in the blood of the two groups was basically the same. On the first day after operation, it was significantly lower than that before operation, and on the third day after operation, it decreased to the lowest value (diabetes group = 203.60 / 109 / L, normal group 209.80 / 109 / L). By the 7th day after operation, the platelet levels in the blood of the two groups returned to the preoperative level. There was no significant difference in PLT counts between the two groups at all time points. The TT,APTT,PT values of the two groups were statistically analyzed and compared. There was no statistical difference in the data of the three groups before and after operation. The data of the three groups were compared at different time points in each group, except for the TT value and APTT value of the diabetic group before and after the first day, there was no statistical significance in the other groups. There was no obvious change trend in these three groups after operation, and all of them fluctuated within normal range. Conclusion 1. After primary unilateral TKA, hypercoagulability in knee osteoarthritis with diabetes was more severe than that in patients with normal fasting blood glucose. 2. 2. The FIB index of knee osteoarthritis patients increased first and then decreased after primary unilateral TKA. Monitoring the changes of FIB index after operation was helpful to evaluate the coagulation status of TKA patients with knee osteoarthritis.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1
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