Causes of deep venous thrombosis after fracture in patients with coronary heart disease and intervention efficiency of argatroban
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摘要:目的 探讨冠心病患者骨折后深静脉血栓(DVT)发生原因及阿加曲班干预效果。方法 选取100例冠心病患者，均为骨折后经B超深静脉探测确诊DVT, 设为研究组。100例未发生DVT患者设为对照组。将研究组患者随机分为A组与B组各50例。A组采取尿激酶治疗, B组采取尿激酶联合阿加曲班治疗。分析冠心病患者骨折后发生DVT的影响因素，比较A组与B组一般资料、临床疗效、治疗前后凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体(D-D)水平及血小板计数(PLT)。结果 研究组年龄大于对照组，卧床时间长于对照组, PT、APTT短于对照组，差异均有统计学意义(P < 0.05)。B组总有效率94.00%, 显著高于A组80.00%(P < 0.05)。治疗后A组与B组PT、APTT较治疗前显著延长，且B组显著长于A组(P < 0.05)。治疗后A组与B组D-D、PLT较治疗前显著降低，且B组显著低于A组(P < 0.05)。结论 冠心病患者骨折后DVT发生与年龄、卧床时间、PT、APTT等有关，阿加曲班治疗DVT疗效显著，能有效改善患者凝血状态，预防DVT发生。Abstract:Objective To investigate the causes of deep venous thrombosis (DVT) after fracture in patients with coronary heart disease (CHD) and intervention efficiency of argatroban.Methods A total of 100 patients with CHD were selected as study group, and all of them were diagnosed as DVT after fracture by B type ultrasound examination. Another 100 patients without DVT were selected as control group. The study group was randomly divided into group A and group B, with 50 cases in each group. Group A was treated with urokinase, and group B was treated with urokinase combined with agatroban. Influencing factors of DVT after fracture in patients with CHD were analyzed, and the general data, clinical efficacy, the prothrombin time (PT), activated partial prothrombin time (APTT), D-dimer (D-D) level and platelet count (PLT) before and after treatment were compared between group A and B.Results In the study group, the age of patients was older than the control group, the bed-rest time was longer than the control group, PT and APTT were shorter than the control group, and there were significant differences (P < 0.05). The total effective rate of group B was 94.00%, which was significantly higher than 80.00% of group A (P < 0.05). After treatment, PT and APTT in group A andgroup B were significantly longer than those before treatment, and PT and APTT in group B were significantly longer than group A (P < 0.05). levels of D-D and PLT in group A and group B were significantly lower than those before treatment, and D-D and PLT in group B were significantly lower than group A (P < 0.05).Conclusion The occurrence of DVT after fracture in patients with CHD is related to age, bed-rest time, PT and APTT. Agathorban is effective in the treatment of DVT, which can effectively improve the coagulation state of patients and prevent the occurrence of DVT.
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表 1 研究组与对照组DVT影响因素比较(x±s)
因素 研究组(n=100) 对照组(n=100) 年龄/岁 61.01±6.12* 55.37±5.60 卧床时间/d 12.71±3.05* 9.30±2.91 PT/s 9.96±1.03* 13.84±1.91 APTT/s 22.40±1.85* 33.82±2.08 PT: 凝血酶原时间; APTT: 活化部分凝血酶原时间。与对照组比较, *P < 0.05。 
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表 2 A组与B组一般资料比较(x±s)
组别 n 男 女 年龄/岁 PT/s APTT/s A组 50 29 21 60.68±5.96 10.02±0.98 22.61±1.91 B组 50 32 18 61.31±6.24 9.89±1.01 21.98±1.79 PT: 凝血酶原时间; APTT: 活化部分凝血酶原时间。
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表 3 2组临床疗效比较[n(%)]
组别 n 显效 有效 无效 总有效 A组 50 18(36.00) 22(44.00) 10(20.00) 40(80.00) B组 50 26(52.00) 21(42.00) 3(6.00) 47(94.00)* 与A组比较, *P < 0.05。
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表 4 A组与B组PT、APTT比较(x±s)
组别 n PT/s APTT/s 治疗前 疗程结束后 治疗前 疗程结束后 A组 50 10.02±0.98 11.19±1.10* 22.61±1.91 29.31±2.15* B组 50 9.89±1.01 12.08±0.99*# 21.98±1.79 31.91±2.50*# PT: 凝血酶原时间; APTT: 活化部分凝血酶原时间。与治疗前比较, *P < 0.05; 与A组比较, *P < 0.05。
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表 5 A组与B组D-D、PLT比较(x±s)
组别 n D-D/(mg/L) PLT/(×109/L) 治疗前 疗程结束后 治疗前 疗程结束后 A组 50 946.33±68.20 510.11±50.28* 228.64±20.51 187.81±16.25* B组 50 950.15±70.11 413.35±45.04*# 230.15±19.37 160.35±15.33*# D-D: D-二聚体; PLT: 血小板计数。与治疗前比较, *P < 0.05; 与A组比较, *P < 0.05。
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[1] 杨新超, 姜曼, 胡钢. Th22细胞及其细胞因子IL-22与冠心病发病机制的研究进展[J]. 临床心血管病杂志, 2017, 33(9): 832-835. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB201709005.htm [2] 覃策, 胡敏. 重庆江北区居民冠心病流行病学调查及危险因素分析[J]. 医学临床研究, 2018, 35(8): 1653-1655. doi: 10.3969/j.issn.1671-7171.2018.08.071 [3] Hamidizadeh L, Haji H B A R, Babaee Baigi M A, et al. Impact of KIF6 Polymorphism rs20455 on Coronary Heart Disease Risk and Effectiveness of Statin Therapy in 100 Patients from Southern Iran[J]. Arch Iran Med, 2015, 18(10): 683-687.
[4] Protty M B, Aithal S, Hickey B, et al. Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis?A retrospective observational study[J]. BMJ Open, 2015, 5(2): e006956. doi: 10.1136/bmjopen-2014-006956
[5] 李文智, 罗林, 杨昆良, 等. CT肺动脉成像联合下肢静脉成像评估肺动脉栓塞与下肢深静脉血栓的相关性[J]. 中国医学影像技术, 2016, 32(4): 521-525. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201604014.htm [6] 解银立, 张大春, 支兴兴, 等. 可取回型下腔静脉滤器预防下肢骨折合并深静脉血栓形成患者围术期肺动脉栓塞的价值研究[J]. 中国全科医学, 2019, 22(6): 715-719. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201906025.htm [7] Kochar A, Hellkamp A S, Lokhnygina Y, et al. Efficacy and safety of rivaroxaban compared with warfarin in patients with carotid artery disease and nonvalvular atrial fibrillation: Insights from the ROCKET AF trial[J]. Clin Cardiol, 2018, 41(1): 39-45. doi: 10.1002/clc.22846
[8] 杨国凯, 杨镛, 万嘉, 等. 阿加曲班与低分子肝素钙在急性下肢深静脉血栓治疗中的对比观察[J]. 贵州医药, 2018, 42(1): 57-59. doi: 10.3969/j.issn.1000-744X.2018.01.022 [9] 徐斌, 顾风雨, 唐彬, 等. 强化药物方案辅助血液循环驱动干预对老年下肢骨折患者术后DVT防治效果的影响[J]. 实用药物与临床, 2017, 20(9): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-LYLC201709016.htm [10] 徐蕾, 谷沫丽, 王翠, 等. 抗血栓泵在预防老年冠心病经皮冠状动脉介入术后患者下肢深静脉血栓中的应用[J]. 解放军护理杂志, 2016, 33(20): 51-52. doi: 10.3969/j.issn.1008-9993.2016.20.014 [11] 刘丽霞, 刘召琼, 张捷, 等. 老年骨折患者术后下肢深静脉血栓发生的危险因素分析[J]. 实用医院临床杂志, 2019, 16(1): 38-40. doi: 10.3969/j.issn.1672-6170.2019.01.013 [12] 祝春霞, 周长钰. 心血管病患者骨折后下肢深静脉血栓形成的相关分析[J]. 中华老年心脑血管病杂志, 2014, 16(6): 602-604. doi: 10.3969/j.issn.1009-0126.2014.06.013 [13] Stone R H, Bress A P, Nutescu E A, et al. Upper-Extremity Deep-Vein Thrombosis: A Retrospective Cohort Evaluation of Thrombotic Risk Factors at a University Teaching Hospital Antithrombosis Clinic[J]. Ann Pharmacother, 2016, 50(8): 637-644. doi: 10.1177/1060028016649601
[14] Valasek A E, Warren P, Kumar R. Klinefelter syndrome as a risk factor for recurrent deep vein thrombosis in an adolescent male: Significance of a thorough physical examination[J]. Pediatr Blood Cancer, 2018, 65(8): e27080. doi: 10.1002/pbc.27080
[15] Simes J, Robledo K P, White H D, et al. D-dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events and Cancer in Stable Coronary Heart Disease Patients: The LIPID Study[J]. Circulation, 2018, 138(7): 712-723. doi: 10.1161/CIRCULATIONAHA.117.029901
[16] Lemańska-Perek A, Krzyzanowska-Gołab D, Pupek M, et al. Analysis of Soluble Molecular Fibronectin-Fibrin Complexes and EDA-Fibronectin Concentration in Plasma of Patients with Atherosclerosis[J]. Inflammation, 2016, 39(3): 1059-1068. http://www.ncbi.nlm.nih.gov/pubmed/27022744
[17] 叶兆莲, 张娇, 莫莉萍, 等. 高龄多发骨折患者术后长期卧床并发深静脉血栓的原因分析[J]. 重庆医学, 2018, 47(1): 101-103. doi: 10.3969/j.issn.1671-8348.2018.01.034 [18] Matsuo H, Matsumura M, Nakajima Y, et al. Frequency of deep vein thrombosis among hospitalized non-surgical Japanese patients with congestive heart failure[J]. J Cardiol, 2014, 64(6): 430-434. doi: 10.1016/j.jjcc.2014.02.028
[19] Viana V B, Melo E R, Terra-Filho M, et al. Frequency of Deep Vein Thrombosis and/or Pulmonary Embolism After Coronary Artery Bypass Grafting Investigation Regardless of Clinical Suspicion[J]. Am J Cardiol, 2017, 119(2): 237-242. doi: 10.1016/j.amjcard.2016.09.056
[20] 余作取, 王锋, 戴寿旺, 等. 股骨粗隆间骨折股骨近端防旋髓内钉内固定前后四物汤加味与肝素联合预防血栓的应用研究[J]. 中华中医药学刊, 2018, 36(2): 502-506. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201802066.htm [21] Spinale J M, Mariani L H, Kapoor S, et al. A reassessment of soluble urokinase-type plasminogen activator receptor in glomerular disease[J]. Kidney Int, 2015, 87(3): 564-574. doi: 10.1038/ki.2014.346
[22] Gosselin R, Grant R P, Adcock D M. Comparison of the effect of the anti-Xa direct oral anticoagulants apixaban, edoxaban, and rivaroxaban on coagulation assays[J]. Int J Lab Hematol, 2016, 38(5): 505-513. doi: 10.1111/ijlh.12528
[23] 何志婷, 刘琼, 梁维, 等. 尿激酶联合阿加曲班对维持性血液透析患者长期血管通路急性血栓形成后溶栓治疗及预防的效果[J]. 疑难病杂志, 2018, 17(9): 909-913. doi: 10.3969/j.issn.1671-6450.2018.09.011 [24] 王宝辉, 王鹏飞, 付亚辉, 等. 下肢骨折患者RAPT评分结合D-二聚体监测预防DVT的意义[J]. 中国骨与关节损伤杂志, 2015, 30(8): 846-848. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201508024.htm -
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