Effect Of ERAS On Postoperative Deep Venous Thrombosis Of Senile Intertrochanteric Fracture

Objective: This paper is aimed at exploring the application and effect of ERAS(Enhanced Recovery After Surgery)on postoperative DVT(deep venous thrombosis)of senile patients with intertrochanteric fracture.Compared with the incidence of DVT after the surgery on senile patients with intertrochanteric fracture under the management mode of the traditional,the author understood and analyzed the incidence of the DVT,risk factors and the differences of factors affecting blood coagulation.Methods: The control group applying the traditional theory consisted of the retrospective case analyses on 49 patients with intertrochanteric fractures from August 2016 to August 2017 in the hospital,while another 42 cases from August 2017 to March 2018 were set as the ERAS group.In addition to different management modes,there were no other significant statistic differences among patients of the two groups in age,gender,BMI,fracture type,and proportion of underlying diseases.Wills evaluation was conducted after their hospitalization,and the blood test was performed for data of four indicators concerning coagulation on the first day,including D-dimer,Prothrombin Time(PT),Activated Partial Thromboplastin Time(APTT),Thrombin Time(TT),fibrinogen(FIB)and blood routines.Before operation,B-ultrasonic of DVT was conducted with the standard for diagnosing DVT set by Society of Surgery,Chinese Medical Association(the third edition).DVT-positive patients would be excluded from the research.For those DVT-negative patients,operations would be performed later,recording their preoperative waiting time,operating time,intraoperative volume of fluid input,statistical transfusion,anesthesia,preoperative analgesia,bone traction,and whether drainage tubes and urinary catheters were placed.On the third day after surgery,routine blood tests were performed to reexamine relevant experimental indicators.According to the standard for diagnosing DVT set by Society of Surgery,Chinese Medical Association(the third edition),patients received examinations on DVT.Meanwhile,their hospital stays and costs were also recorded.All the data were input into the SPSS17.0 software package for statistical analysis to compare the incidence of DVT under different management modes in the two groups.Logistic regression analysis was used to screen the blood coagulation indexes and treatment measures most relevant to the incidence of DVT.Accordingly,the analysis on the variation value of blood coagulation indicators demonstrated that the incidence of DVT varied under different management modes.Results: The incidence of DVT was 14.3% in the ERAS group and 26.5% in the other group.The incidence of DVT in the ERAS group was significantly lower than that in the control group(P<0.05).P values of the logistic regression analysis on the preoperative waiting time,preoperative traction,and pre-hospitalization block analgesia with postoperative DVT were respectively 0.004,0.032 and 0.034.There was no correlation among D-dimer,FIB and preoperative DVT.P values of the logistic regression analysis on D-dimer and FIB with postoperative DVT were respectively 0.001 and 0.005.In ERAS group,the mean values of D-dimer and FIB were 1.21 and 4.03,lower than that of the control group which were 1.41 and 5.11(P<0.05),registering a statistic difference.The difference of the preoperative and postoperative mean values of D-dimer in ERAS group was 0.30,higher than that of the control group which was 0.13,while value of FIB in ERAS group was 0.09,lower than that of the control group which was 0.92.Conclusion: 1.The application of the ERAS on surgery of senile intertrochanteric fracture is conductive to reducing the incidence of postoperative DVT.(1)Shortening preoperative waiting time,avoiding preoperative bone traction,and preoperative regional block analgesia have clinical significance in reducing the incidence of DVT after operation of femoral intertrochanteric fracture in elderly patients.(2)D-dimer,FIB may indicate the occurrence of DVT of postoperative operation of femoral intertrochanteric fracture in elderly patients.