發(fā)布時間：2018-01-20 13:22

  本文關(guān)鍵詞： 老年骨折 深靜脈血栓 小腿肌間靜脈血栓 利伐沙班 低分子肝素　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:隨著老齡化步伐的加快,我國老年人口日趨龐大,由于身體機能衰退,反應(yīng)能力遲緩,同時老年人多伴有骨質(zhì)疏,輕微的外力就可以導(dǎo)致骨折。深靜脈血栓是老年骨折患者常見的并發(fā)癥,嚴(yán)重影響患者生活質(zhì)量,嚴(yán)重者威脅生命。在老年骨折患者圍手術(shù)期進行深靜脈血栓的預(yù)防和治療具有重要臨床意義。方法:選取我科200例老年骨折患者病例,探索骨折部位、年齡、手術(shù)時間、Caprini評分、合并癥、以及利伐沙班和低分子肝素在老年骨折患者圍手術(shù)期深靜脈血栓形成過程中的預(yù)防和治療效果評估。結(jié)果:1:年齡:本研究將老年骨折患者分為2組,一組為65-74歲之間,一組為75歲及以上。統(tǒng)計分析顯示75歲以上骨折患者形成小腿肌間靜脈血栓的概率更高。2:患病部位:老年骨折患者骨折部位大部分為髖部骨折,骨盆骨折次之,二者形成肌間靜脈血栓的概率更高。3:Caprini評分:由于患者年齡大,同時伴有并發(fā)癥,所以大部分患者Caprini評分都在3分以上,均屬于中高危險人群,建議給予物理、藥物預(yù)防和治療。4:合并癥:伴有糖尿病、高血壓、冠心病老年骨折發(fā)生深靜脈血栓概率比無合并癥患者高,建議圍手術(shù)期進行物理、藥物預(yù)防和治療。5:手術(shù)時間:手術(shù)時間大于3小時患者患小腿肌間靜脈血栓的風(fēng)險性更大,手術(shù)最好在盡可能短的時間內(nèi)完成。6:治療藥物:本研究比較了低分子肝素和利伐沙班治療小腿肌間靜脈血栓的效果和安全性,結(jié)果顯示二者均有效治療小腿肌間靜脈血栓,且能阻止其向DVT發(fā)展,但是利伐沙班治療效果略好于低分子肝素,且無并發(fā)癥發(fā)生。利伐沙班且具有良好的用藥安全性,值得在臨床推廣。結(jié)論:老年患者圍手術(shù)期應(yīng)綜合患者年齡、合并癥、骨折部位、Caprini評分等因素給予物理預(yù)防和藥物治療,利伐沙班在小腿肌間靜脈血栓的治療中預(yù)后較好、且更具安全性。
[Abstract]:Objective: with the accelerated pace of aging, China's elderly population is growing larger, due to the decline of physical function, slow response, and the elderly more accompanied by bone thinning. Deep venous thrombosis (DVT) is a common complication in elderly patients with fractures, which seriously affects the quality of life of patients. It is very important to prevent and treat deep venous thrombosis in the perioperative period of senile fracture patients. Methods: 200 cases of senile fracture patients in our department were selected to explore the fracture site. Age, operative time, Caprini score, complications. Evaluation of the prevention and treatment effect of Levasaban and low-molecular-weight heparin in perioperative deep venous thrombosis in elderly patients with fracture. Results: 1: age: this study divided the elderly patients into two groups. One group was between 65 and 74 years old. One group was 75 years old and over. Statistical analysis showed that patients over 75 years of age had a higher probability of developing intermuscular vein thrombosis in the leg. 2. The location of the disease: the fracture site of the elderly fracture patients was mostly hip fracture. Pelvic fractures followed, with a higher probability of intramuscular venous thrombosis. 3: Caprini score: because of the age of the patient, accompanied by complications. So most patients with Caprini score above 3, all belong to the high risk group, recommended to physical, drug prevention and treatment .4: complications: accompanied by diabetes, hypertension. The incidence of deep venous thrombosis in elderly patients with coronary heart disease is higher than that in patients without complications. Perioperative physical therapy is recommended. Drug prophylaxis and treatment .5: operative time: patients with more than 3 hours of surgery have a greater risk of developing intermuscular vein thrombosis in the leg. Surgery is best done in as short a time as possible. 6: therapeutic drugs: this study compared the efficacy and safety of low-molecular-weight heparin and rivastaban in the treatment of intermuscular vein thrombosis in the leg. The results showed that both of them were effective in the treatment of intermuscular vein thrombosis of the leg and could prevent the development of DVT, but the effect of livasaban was slightly better than that of low molecular weight heparin (LMWH). There are no complications. Rivastaban has good drug safety, it is worth popularizing in clinic. Conclusion: the elderly patients should synthesize the patient's age, complication and fracture site in perioperative period. Caprini score and other factors were given physical prevention and drug therapy. Rivastaban had a better prognosis and more safety in the treatment of intermuscular vein thrombosis of the leg.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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