发布时间：2014-10-17 来源：人大经济论坛

关于低分子肝素钙预防老年髋关节骨折患者形成静脉血栓的护理  摘　要 目的：探讨下肢静脉血栓（deep venous thrombosis，DVT）形成是老年髋关节骨折最常见的并发症之一，齐宝庆等[1] 报道，如果不进行干预，采取保守治疗的老年髋关节骨折患者，DVT 的发生率为56.67%。十九世纪中期，法国Virchow最早提出静脉血栓形成的三大因素：静脉血流缓慢；静脉壁的损伤；血液高凝状态[2] 至今仍为各国学者所公认。DVT好发部位为下肢，常见于骨科大手术后，DVT可造成肢体残疾，甚至继发致命性肺栓塞（pulmonaryembolism，PE），由此可见DVT 预防的重要性[3]。高龄、髋部创伤及手术均为DVT 的高危因素[4，5]。 方法：髋关节骨折病人的多数是老年人，常合并多系统、多器官的生理退变和(或)器质性病变，血液处于高凝状态；这些患者术前多因活动明显减少，术后切口疼痛、麻醉反应等又使活动明显受限，使下肢血流处于滞缓状态。同时血液还原粘度和纤维蛋白原增高也是形成DVT的因素。因其极易被忽视，多数病人未能得到及时的诊治，不仅影响原发病的治疗，且极易演变成血栓形成后遗症。下肢深静脉血栓形成最主要而常见的后遗症，是下肢深静脉血栓形成综合征。长期影响患者生活，少数患者可发生肺栓塞，严重威胁生命安全。 目前世界上普遍采用低分子肝素预防治疗DVT的发生： 结果：低分子肝素是将肝素经化学或酶解聚后生成平均分子量在4000~6500间的肝素片段。因分子量较小，不易被在血栓形成中血小板释血的血小板第Ⅳ因子中和，抗凝效果和纤溶作用得以增强，而抗血小板、诱发出血的作用大为减弱，对脂质代谢的影响极小，加之生物利用度高达98%，量效关系明确、固定剂量时抗凝效果易于预测，血浆半衰期较普通肝素长2~3倍，不透过胎盘屏障，例如，释放组织因子途径抑制物(tissuef actorp athwayi nhibitor,TFPI)和组织型纤溶酶原活化素，调节细胞粘连分子，从血管壁释放促纤溶和抗血栓介质，使血循环中von Willebrand因子和致炎细胞因子减少，还有对血流变学的影响以及与血小板和白细胞的相互作用[5-7] TFPI是外源凝血途径的生理性抑制物， 结论：故而进行积极有效的抗凝是治疗老年髋关节骨折患者静脉血栓的重要方法，而且我们已经取得了令人满意的效果。 关 键 词：老年人；静脉血栓；低分子肝素钙 论文类型：理论研究 Abstract Goal: The discussion lower limb vein thrombus (deep venous thrombosis, DVT) forms is one of old age coxa bone fracture most common complications, Qi Bao celebrates and so on to report, if does not carry on the intervention, adopts the conservative treatment the old age coxa bone fracture patient, the DVT formation rate is 56.67%.The 19th century intermediate stages, French Virchow most early proposes the phlebothrombosis three big factors: The vein blood stream is slow; Vein wall damage; The blood congealed condition still to recognize until now high as the various countries' scholar.DVT good sends the spot is a lower limb, after orthopedics major surgery, DVT may create the body disability common, even continues sends the lethality pulmonary embolism (pulmonaryembolism, PE), thus it can be seen DVT prevention important .The advanced age, the hip department wound and the surgery are DVT high-risk factor . Method: Coxa bone fracture patient's most is the senior citizen, often merges the multi-systems, the multi-organ physiology draws back changes with (or) the organic pathological change, the blood is at congeals high the condition; In front of because these patient technique many moves reduces obviously, after the technique the margin ache, the anaesthesia response and so on cause the activity to receive obviously limit, cause the lower limb blood stream to be at the slow condition.Simultaneously the blood return to original state viscosity and the fibrinogen advance also are form DVT the factor.Because it is neglected extremely easily, the most patients have not been able to obtain the prompt diagnosis, not only the influence the primary affection treatment, also extremely easy to evolve the thrombus to form the sequela. The lower limb deep phlebothrombosis are most main and the common sequela, is the lower limb deep phlebothrombosis synthesis drafts.Affects the patient to live for a long time, the minority patient may have the pulmonary embolism, threatens the safety seriously. At present in the world generally uses the low molecular heparin prevention to treat DVT the occurrence: Finally: During the low molecular heparin is produces the heparin after chemistry or the enzyme depolymerization the mean molecular weight in 4000~6500 heparin fragments.Because the molecular weight is small, is formed in the thrombus the blood platelet to release not easily the blood the blood plateletⅣFactor neutral, the antifreeze effect and the filament dissolve the function to be able to strengthen, but the anti-blood platelet, the suggestion hemorrhage function for is weaken greatly, is minimum to the lipin metabolism influence, adds the biological exploitability to reach as high as 98%, measures the effect relations is clear about, when the fixed dosage prevents clotting the effect easy to forecast, blood plasma half-life ordinary heparin long 2~3 times, do not penetrate the placenta barrier, for example, the release organizes the factor way inhibitor (tissuef actorp athwayi nhibitor, TFPI) and theorganization plasmin original activation element, the adjustment cell adhesion member, presses the filament from the blood vessel wall release to fuse theanti-thrombus medium, causes in the blood circulation von the Willebrand factor and sends the phlogocyte factor to reduce, but also has to the blood rheology influenceAs well as affects TFPI with the blood platelet and the white blood cell is mutually the extraneous source hemoglutination way physiology inhibitor, Conclusion: Therefore carries on the positive effective antifreeze is treats the old age coxa bone fracture patient vein thrombus the important method, moreover we have already obtained the satisfying effect. Key word: Senior citizen; Vein thrombus; Low molecular heparin calcium paper type: Fundamental research 目 录 1 绪论9 1.1本研究的背景和意义9 1.2本研究的目的与目标9 1.2.1研究的目的9 1.2.2研究的目标9 1.3关键词及定义9 1.4 文献回顾9 1.4.1老年髋关节骨折的发生情况9 1.4.2下肢深静脉血栓形成9 1.4.3 低分子肝素钙对于预防DVT的作用10 2方法错误！未定义书签。 2.1研究对象错误！未定义书签。 2.2一般资料错误！未定义书签。 2.3研究方法错误！未定义书签。 2.4研究对象错误！未定义书签。 2.5研究工具17 2.6研究步骤研究方法18 3.结果19 4.讨论20 参考文献23