【摘要】 目的研究全髋关节置换术中使用小剂量肝素的有效性和安全性。方法在纽约特种外科医院的行全髋关节置换的患者共993例,从2006年1月到2010年5月。其中男473例,女529例,均排除了患有血小板减少症、出血体质以及不能行硬膜外麻醉的患者。手术采用硬膜外低压麻醉(平均动脉压维持在45~55 mm Hg),行后外侧切口,尽量减少股静脉扭曲的时间,反复冲洗和吸引出股骨髓腔内容物。当处理髋臼侧的时候,下肢处于中立位置。处理股骨侧髓腔之前2~3 min,静脉给予肝素(10~15 U/kg)。结果此组患者平均手术时间83分钟(35~268 min),平均失血量183 ml(50~1400 ml)。术后随访3个月。本组患者共有13例发生血栓性疾病,占患者总数的1.3%。所有血栓患者中确诊为DVT的有10例,发生率为1%。没有一例患者发生切口血肿及主要出血并发症。随访期间没有一例患者死亡。结论全髋关节术中给予肝素血栓发生率低,术后无相关的出血并发生。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of introperative heparin in the total hip arthroplasty.Methods Between Jan,2006 and May,2010,993 consecutive patients who underwent THA were observed.The exclusion cretiria were that patients with thrombocytopenia or bleeding diathesis and the patients for whom epidural analgesia was not possible.The median age of the patients was 64 years( range,20- 96years); 52.8% were women( 529 of 933); 47.2% were men( 473 0f 933).The surgeries were performed under hypotensive epidural anestheisa( mean arterial pressure was between 45- 55 mm Hg).Through a posterolateral approach,the duration of femoral vein obstruction was minimized and the load of intramedullary content to the venous system was reduced as much as possible by repeatedly pulsatile lavaging and suctioning the femoral canal.Patients received one bolus of unfractionated intravenous heparin( 10-15 U/kg),one to two minutes before femoral canal preparation.Results Surgery was performed for83 minutes in average( range,35- 256 min).The mean blood loss was 183 ml( 50- 1400 ml).All patients were followed up at least three months postoperatively.No patient was lost for follow-up.The incidence of clinical symoptomatic VTE was 1.3%( 13 of 933).The incidence of deep vein thrombosis was 1%.No patient died during the follow-up and there was no major bleeding episode or incision hematoma.Conclusion Intraoperative heparin appears a safe and efficacious measure for thrombo-embolic prophylaxis.更多还原