冠脉支架术后患者行髋关节置换术的围手术期抗凝治疗体会(1)
[摘要] 目的 探讨冠脉支架植入术后患者行髋关节置换术的围手术期抗凝治疗策略。 方法 回顾性分析我科2010年1月～2017年1月收治的15例冠脉支架术后行髋关节置换患者的临床资料，观察住院期间心绞痛、心肌梗死、缺血性室性恶性心律失常发生情况及出血、血栓的发生情况，总结该类患者围手术期的抗凝治疗方案。 结果 15例患者的术中出血量为230～520 mL，平均(347±81)mL；术后引流量为350～680 mL，平均(460±75)mL。术后无一例出现重度出血以及无一例因大量出血而导致计划外输血或需手术止血等出血事件，1例出现术后拔除伤口引流管后引流管口处持续渗血，伤口处予局部加压包扎，5 d后渗血消失。无一例出现下肢深静脉血栓及瓣膜血栓及发生心绞痛、心肌梗死、缺血性室性恶性心律失常等。 结论 冠脉支架术后髋关节置换患者围手术期合理选择抗凝方案，可以降低围手术期心脏事件的发生率，并且不增加血栓及出血的风险。
[关键词] 关节置换；冠脉支架；围手术期；抗凝
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2018)03-0060-03
The experience of perioperative anticoagulation therapy in patients undergoing hip arthroplasty after coronary stenting
XIANG Liang HE Honghui ZHANG Wei
Department of Joint and Sports Medicine， Affiliated Nanhua Hospital， University of South China， Hengyang 421002， China
[Abstract] Objective To investigate the perioperative anticoagulation strategies for patients undergoing hip arthroplasty after coronary stenting. Methods The clinical data of 15 patients undergoing total hip arthroplasty who underwent coronary stenting from January 2010 to January 2017 in our department were retrospectively analyzed. Situation of angina pectoris， myocardial infarction， ischemic ventricular arrhythmia， bleeding and thrombus were observed during hospitalization. The perioperative anticoagulant treatment of such patients were summarized. Results Intraoperative blood loss volume of 15 cases was 230-520 mL， an average of(347±81) mL； postoperative drainage volume was 350-680 mL， an average of(460±75) mL. None of the patients had severe bleeding after operation， and no case of unplanned blood transfusion caused by massive bleeding or bleeding calling for surgical hemostasis. One patient had sustained bleeding at the nozzle of drainage tube after removing the drainage tube. Local wound dressing was applied and the bleeding disappeared after 5 days. No case of deep venous thrombosis and valvular thrombosis， angina pectoris， myocardial infarction， ischemic ventricular arrhythmia， etc. Conclusion Rational choice of treatment for perioperative anticoagulation in patients undergoing total hip arthroplasty can reduce the incidence of perioperative cardiac events without increasing the risk of thrombosis and hemorrhage.
[Key words] Joint replacement； Coronary stent； Perioperative period； Anticoagulation
關节置换术是近代骨科发展的最大成就之一，目前因各种疾病需行关节置换的患者越来越多，各种围手术期复杂情况引起骨科医生的广泛关注[1]。髋关节置换术后患者血液处于高凝状态，有发生下肢深静脉血栓甚至发生肺栓塞可能，在这类患者中有一些患冠心病既往行冠脉支架植入术的患者，这些患者围手术期的处理有其特殊性，尤其是在抗凝治疗上，需要平衡出血与血栓的风险，处理不当可导致心梗、恶性心律失常、颅内出血、手术部位大出血等极其严重的并发症，所以该类患者行关节置换如何把握手术时机、如何选择合适的抗凝方案成为治疗的关键，目前国内外鲜见相关文献报道。本文通过回顾性分析2010年1月～2017年1月15例冠脉支架术后行髋关节置换术患者的临床资料，探讨冠脉支架术后髋关节置换患者围手术期的抗凝策略。, http://www.100md.com(向亮 贺洪辉 张卫)
[关键词] 关节置换；冠脉支架；围手术期；抗凝
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2018)03-0060-03
The experience of perioperative anticoagulation therapy in patients undergoing hip arthroplasty after coronary stenting
XIANG Liang HE Honghui ZHANG Wei
Department of Joint and Sports Medicine， Affiliated Nanhua Hospital， University of South China， Hengyang 421002， China
[Abstract] Objective To investigate the perioperative anticoagulation strategies for patients undergoing hip arthroplasty after coronary stenting. Methods The clinical data of 15 patients undergoing total hip arthroplasty who underwent coronary stenting from January 2010 to January 2017 in our department were retrospectively analyzed. Situation of angina pectoris， myocardial infarction， ischemic ventricular arrhythmia， bleeding and thrombus were observed during hospitalization. The perioperative anticoagulant treatment of such patients were summarized. Results Intraoperative blood loss volume of 15 cases was 230-520 mL， an average of(347±81) mL； postoperative drainage volume was 350-680 mL， an average of(460±75) mL. None of the patients had severe bleeding after operation， and no case of unplanned blood transfusion caused by massive bleeding or bleeding calling for surgical hemostasis. One patient had sustained bleeding at the nozzle of drainage tube after removing the drainage tube. Local wound dressing was applied and the bleeding disappeared after 5 days. No case of deep venous thrombosis and valvular thrombosis， angina pectoris， myocardial infarction， ischemic ventricular arrhythmia， etc. Conclusion Rational choice of treatment for perioperative anticoagulation in patients undergoing total hip arthroplasty can reduce the incidence of perioperative cardiac events without increasing the risk of thrombosis and hemorrhage.
[Key words] Joint replacement； Coronary stent； Perioperative period； Anticoagulation
關节置换术是近代骨科发展的最大成就之一，目前因各种疾病需行关节置换的患者越来越多，各种围手术期复杂情况引起骨科医生的广泛关注[1]。髋关节置换术后患者血液处于高凝状态，有发生下肢深静脉血栓甚至发生肺栓塞可能，在这类患者中有一些患冠心病既往行冠脉支架植入术的患者，这些患者围手术期的处理有其特殊性，尤其是在抗凝治疗上，需要平衡出血与血栓的风险，处理不当可导致心梗、恶性心律失常、颅内出血、手术部位大出血等极其严重的并发症，所以该类患者行关节置换如何把握手术时机、如何选择合适的抗凝方案成为治疗的关键，目前国内外鲜见相关文献报道。本文通过回顾性分析2010年1月～2017年1月15例冠脉支架术后行髋关节置换术患者的临床资料，探讨冠脉支架术后髋关节置换患者围手术期的抗凝策略。, http://www.100md.com(向亮 贺洪辉 张卫)