The Study Of Early Diagnosis And Intervention Therapy On PTE Resulted From Bone Trauma

Objective :â‘ To explore the effective indicator of early diagnosis of bone trauma complicated with DVT and PTE.â‘¡To observe the abiogenesis occurrence of bone trauma complicated with DVT and PTE.â‘¢To observe the occurrence of bone trauma complicated with DVT and PTE after heparin and AV pump therapy.â‘£To evaluate the efficacy and safe of heparin, Low Molecular Heparin and AV pump therapy on DVT and/or PTE.Method:132 hospitalized patients with bone trauma (pregnancy women, patients with trauma histroy, patients lying in bed for long time, patients with malignant tumour,diabetic,connective tissue disease, reactive internal hemorrhage, supersensitivity to heparin, thrombopenia related to heparin, large area pulmonary thromboembolism were ruled out). Large sample proapective random and comparison study were deployed. 3 ml venous blood were taken 12 hours, 24 hours, 48 hours, 3 days, 7 days, 14 days , 21 days after trauma. ELISE method was adopted in measurements of D-Dimer,PT,APTT,AT-â…¢levels. Lung spiral CT, Color ultrasound on both lower extremities and heart. The patients with D-D positive lasting for 48 hours divided into 2 groups radomly:prophylaxis groups and non-prophylaxis groups. Patients in prophylaxis groups were divided into 3 groups : low-dosege unfractionated heparin group ( 5000IU,Tid,iH,7-10days),low molecular heparin group ( 0.1ml-0.3ml/10kg ,iH,7-10 days), and AV pump group(administrated 24 hours per day,for 7 days successive).Results:1. The PT,APTT and AT-â…¢levels were all reduced in different extent in both groups,and the differents of PT and APTT levels between the two groups had no significance,but the AT-â…¢levels in DVT and/or PTE patients were significant lower than those in non- DVT and/or PTE patients.2. D-D levels increased obviously in 48 hours after the trauma,and the increase in DVT and/or PTE patients were more significant,and the last time were longer than that in non- DVT and/or PTE patient(sP<0.05). Look on 500ng/ml as boundary rating, combined with clinical symptom,spiral CT results,nuclide lung perfusion scan and ultrasonic inspection,the negative results were all coincident to non-DVT and/or PTE patients in 48 hours after trauma.The abiogenesis rate of DVT and PTE were 41.43% and 11.43% respectively. And the heparin therapy can reduced the incidence rate of DVT and/or PTE significantly(P<0.01). The effects of DVT and/or PTE prophylaxis in UFH,LMWH,and AV pump groups had no difference. The occurrance rate of side effects of heparin therapy, as thrombocytopenia,disturbance of blood coagulation,were almost same in different groups. The prophylaxis effects in AV pump had no difference to that in heparin groups.Conclusion:1. the serum D-D level was a reliable indicator in Screening the suspective patients with DVT and/or PTE combined with clinical symptom,Color ultrasound results.2. The abiogenesis rate of DVT and/or PTE were related with injury region,and the relation were determinated by the time lying in bed. And The abiogenesis rate of DVT and/or PTE were also related with receiving operation.3. The intervention therapy of UFH,LMWH,and AV pump can reduced the incidence rate of DVT and/or PTE significantly.4. The occurrance of side effect of UFH and LMWH in prophylaxis of DVT and/or PTE are same.