中国医药指南

目的 探讨不同治疗时间对老年髋部骨折患者围手术期抗凝效果的影响。方法 选择2020年1月至2023年12月期老年髋部骨折手术患者280例为对象，根据不同治疗时间分为A组、B组、C组和D组，各70例。其中，A组患者及时治疗，即伤后3 d内就诊，经抗凝后再进行手术治疗，B组及时治疗，即伤后3 d内就诊，但术前无抗凝治疗，术后给予抗凝干预；C组未及时治疗，伤后卧床> 1周，就诊时开始抗凝治疗再进行手术干预；D组未及时治疗，伤后卧床> 1周，就诊时未抗凝治疗即手术，比较各组凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、D-二聚体（D-D）凝血功能指标、下肢水肿、肺栓塞、脑栓塞发生率。结果 A组干预前后凝血功能变化不明显，干预前指标均低于B组、C组和D组（P <0.05），干预后A组D-D指标高于B组与C组，低于D组（P <0.05）。B组干预前未给予抗凝治疗，凝血功能明显异常，但低于C组和D组（P <0.05）。C组干预前长期卧床，凝血功异常，但是治疗前给予抗凝干预，凝血指标低于D组（P <0.05）。随访3个月中A组下肢水肿、肺栓塞及脑栓塞发生率低于B组、C组和D组（P <0.05）。4组下肢水肿、肺栓塞及脑栓塞发生率从低到高分别为A组 0.05）。结论 不同治疗时间对老年髋部骨折患者围手术期抗凝效果影响明显，且患者伤后3 d内就诊，经抗凝后在进行手术治疗，有助于降低下肢水肿、肺栓塞、脑栓塞发生率，能改善患者凝血功能。

Objective To investigate the effect of different treatment time on perioperative anticoagulation in elderly patients with hip fracture.Methods A total of 280 elderly patients with hip fracture surgery from January 2020 to December 2023 were selected and divided into group A,group B, group C and group D with 70 cases in each group according to different treatment time. Among them, patients in group A received timely treatment, that is, they were treated within 3 days after injury and then underwent surgery after anticoagulation. Group B received timely treatment,that is, treatment within 3 days after injury, but no anticoagulation treatment before surgery, and anticoagulation intervention after surgery. Group C was not treated in time and stayed in bed for more than 1 week after injury. Anticoagulation therapy was started at the time of treatment and then surgical intervention was performed. Group D was not treated in time, stayed in bed for more than 1 week after injury, and did not receive anticoagulant treatment, that is, surgery, at the time of treatment. The prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), D-dimer(D-D) coagulation function indexes, lower limb edema, pulmonary embolism and cerebral embolism were compared among all groups. Results The clotting function of group A was not significantly changed before and after intervention, and the indexes before intervention were lower than those of groups B, C and D(P<0.05), and the D-D indexes of group A were higher than those of groups B and C, but lower than those of group D(P<0.05). Group B was not given anticoagulant therapy before intervention, and the coagulation function was obviously abnormal, but lower than that in groups C and D(P<0.05). Group C stayed in bed for a long time before intervention, and coagulation function was abnormal, but given anticoagulation intervention before treatment, coagulation index was lower than group D(P<.05). The incidence of lower extremity edema, pulmonary embolism and cerebral embolism in group A was lower than that in groups B, C and D at 3 months of follow-up(P<0.05). The incidence rates of lower limb edema, pulmonary embolism and cerebral embolism in the four groups were from low to high in group A0.05). Conclusions Different treatment time has significant infiuence on perioperative anticoagulation effect in elderly patients with hip fracture. In addition, patients who seek treatment within three day after injury and receive surgical treatment after anticoagulation can help reduce the incidence of lower limb edema, pulmonary embolism and cerebral embolism, and improve the coagulation function of patients.