| 摘要: |
| 目的 探讨血栓栓塞风险评分（CHA2DS2-VASc评分）在老年髋部骨折伴非瓣膜性心房颤动（NVAF）患者围手术期分层抗凝管理中的应用效果。方法 回顾性纳入78例老年髋部骨折伴NVAF患者，根据术前CHA2DS2-VASc评分对患者年龄、性别、糖尿病、高血压、心力衰竭、脑卒中及血管疾病史进行评分，并将患者分成3组：低危组（≤1分，18例）、中危组（>1～2分，36例）、高危组（>2分，24例），3组患者术前5 d均改用低分子肝素桥接抗凝，术后24～48 h分别予阿司匹林、利伐沙班、低分子肝素分层抗凝。比较3组患者的一般临床资料、术中出血量、术后引流量和血红蛋白量、围手术期国际标准化比值（INR）、术后1年并发症的发生率、术后1年老年髋部骨折功能恢复量表（FRS）评分。结果 低、中、高危组患者的CHA2DS2-VASc评分分别为（0.56±0.48）、（1.73±0.23）和（5.62±0.76）分，3组比较差异有统计学意义（P<0.01）。3组患者的性别差异无统计学意义（P=0.506）。3组患者年龄差异有统计学意义（P<0.01），低危组年龄最小，高危组年龄最大。中、高危组有既往糖尿病、高血压、充血性心力衰竭、缺血性脑卒中或短暂性脑缺血发作（TIA）及血管疾病史的患者比例均较低危组高，差异均有统计学意义（P均<0.05）；高危组有既往缺血性脑卒中或TIA史的患者比例较中危组高，差异有统计学意义（P=0.031）；中危组与高危组有既往心力衰竭、高血压、糖尿病及心血管疾病的患者比例差异均无统计学意义（P均>0.05）。3组患者手术时间、术中出血量、术后引流量，术前、术后1 d、术后3 d血红蛋白水平和INR，术后1年缺血性/出血性脑卒中、急性冠状动脉综合征、深静脉血栓的发生率，以及术后1年FRS评分差异均无统计学意义（P均>0.05），且3组均无死亡病例。结论 CHA2DS2-VASc评分可根据血栓风险因素指导老年髋部骨折伴NVAF患者围手术期抗凝药物的分级使用策略。 |
| 关键词: CHA2DS2-VASc评分 髋部骨折 围手术期 抗凝 非瓣膜性心房颤动 老年人 |
| DOI：10.16781/j.0258-879x.2021.07.0818 |
| 投稿时间：2021-03-02修订日期：2021-05-07 |
| 基金项目: |
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| Application of CHA2DS2-VASc score in perioperative anticoagulation of elderly hip fracture patients with non-valvular atrial fibrillation |
| LAI Jin,LI Xiao-ming,FANG Liang-qin,HE Xiang* |
(Department of Orthopaedics, No. 72 Army Group Hospital of PLA, Huzhou 313000, Zhejiang, China
*Corresponding author) |
| Abstract: |
| Objective To explore the application of CHA2DS2-VASc score in perioperative stratified anticoagulation for elderly hip fracture patients with non-valvular atrial fibrillation (NVAF). Methods A total of 78 elderly hip fracture patients with NVAF were enrolled. Age, gender, diabetes mellitus, hypertension, heart failure, stroke and vascular disease history were scored according to the preoperative CHA2DS2-VASc score, and the patients were divided into 3 groups:low-risk group (CHA2DS2-VASc score ≤ 1, 18 cases), medium-risk group (CHA2DS2-VASc score >1-2, 36 cases), and high-risk group (CHA2DS2-VASc score>2, 24 cases). Three groups were all switched to low molecular heparin for bridging anticoagulation 5 days before operation, and treated with aspirin, rivaroxaban and low molecular heparin for stratified anticoagulation 24-48 h after operation. The general clinical data, intraoperative blood loss, postoperative drainage and hemoglobin, perioperative international normalized ratio (INR), incidence of complications in 1 year after operation and the elderly hip fracture functional recovery scale (FRS) score were compared among the 3 groups. Results The CHA2DS2-VASc scores of patients in the low-, medium- and high-risk groups were 0.56±0.48, 1.73±0.23 and 5.62±0.76, respectively, showing significant differences (P<0.01). There was no significant difference in gender among the 3 groups (P=0.506). There was significant difference in age among the 3 groups (P<0.01), with patients in the low-risk group being the youngest and those in the high-risk group being the oldest. Compared with the low-risk group, the proportions of patients with previous diabetes mellitus, hypertension, congestive heart failure, ischemic stroke or transient ischemic attack (TIA), and vascular disease were significantly higher in the medium- and high-risk groups (all P<0.05); the proportion of patients with previous ischemic stroke or TIA was significantly higher in the high-risk group than in the medium-risk group (P=0.031); there were no significant differences in the proportions of patients with previous heart failure, hypertension, diabetes mellitus or cardiovascular disease between the medium- and high-risk groups (all P>0.05). There were no significant differences in operation time, intraoperative blood loss, postoperative drainage, hemoglobin levels or INR before, 1 d after, and 3 d after operation among the 3 groups, and the same was true for the incidences of ischemic/hemorrhagic stroke, acute coronary syndrome, deep vein thrombosis, and FRS scores 1 year after operation (all P>0.05). There were no deaths among the 3 groups. Conclusion The CHA2DS2-VASc score can guide the use of perioperative stratified anticoagulants in elderly hip fracture patients with NVAF according to the risk factors of thrombosis. |
| Key words: CHA2DS2-VASc score hip fracture perioperative period anticoagulation non-valvular atrial fibrillation aged |
