Development Regularity Of TCM Syndrome Types,Risk Of Deep Vein Thrombosis And Thrombelastography In Surgical Patients In Department Of Orthopedic

ObjectiveTo investigate the change tendency of coagulation state,risk score of venous thromboembolism and TCM syndrome types in the pre-operative period in elderly patients with femoral neck fractures.Provide a reference for the chinese and western prevention of DVT in the pre-operative period.Methods100 patients who met the inclusion criteria in the Foshan Hospital of traditional Chinese medicine from March 2017 to december 2017.To analysis the clinical characteristic of all patients.The blood samples of all patients were respectively collected for TEG and the Autar and Caprini risk assessment scale was used to assess VTE risk assessment in the first day after hospitalized and 1th?3th?7th postoperative day.The evolving regular of TCM syndrome types during Perioperative Period were reseached.The date above was collected.To disclose the change tendency of coagulation state,risk score of venous thromboembolism and TCM syndrome types in the pre-operative period.The authenticity and reliability of the Autar and Caprini scoring system was validated using recemer operator characteristic curve(ROC).Results1.In the first day after hospitalized,Sthenia syndrome accounted for 68%,Heat of excess syndrome accounted for 11%,Both of asthenia syndrome and heat of deficiency syndrome accounted for 10%,Insufficiency and excess syndrome accounted for 11%.The differences of the TCM syndrome distribution in the first day after hospitalized compared with the 1th,3th and 7th day after surgery were insignificant(P<0.05).After surgery in 1th day The TCM syndrome transform from Sthenia and Heat of excess syndrome to Asthenia syndrome,Insufficiency and excess syndrome or heat of deficiency syndrome.In the 1th and 7th day after surgery the distribution of TCM syndrome compared with the 1th after surgery is no differences(P>0.05).At the same time the distribution of TCM syndrome between the 3th and 7th day after surgery is no differences(P>0.05).According to the Autar rating scale,The rate of high risk patients in the Sthenia syndrome,Heat of excess syndrome and Insufficiency and excess syndrome accounted for 33.49%?33.33% and 34.11% repectively,and higher than the asthenia syndrome(P<0.05).The rate of low patients in the asthenia syndrome accounted for 23.21% higher than the the Sthenia syndrome,Heat of excess syndrome and Insufficiency and excess syndrome(P<0.05).The distribution of Autar rating scale between asthenia syndrome and heat of deficiency syndrome(P>0.05).2.According to the change tendency of ? volumes of TEG.The blood coagulation function reached the peak in the 1th day after hospitalized(P<0.05).In the 1th day after hospitalized and 1th postoperative day the blood coagulation function become hypercoagulable according to the change tendency of R? MA and CI volumes of TEG(P<0.05).According to the change tendency of K volumes of TEG,in the 1th day after hospitalized,1th and 3th postoperative day the blood kept hypercoagulable(P<0.05).Overall,the blood kept hypercoagulable in the 1th day after hospitalized and 1th postoperative day.And in the 3th and 7th postoperative day the hypercoagulable state slightly declined.3.Both of the Autar and Caprini scores decreased gradually in the pre-operative period,but the scores of Autar and Caprini slightly decreased in the 3th and 7th postoperative day.According to the Autar rating scale,the patients with high risk accounted for 60% in the 1th day after hospitalized higher than the day in the 1th,3th and 7th postoperative day.From the 1th day after surgery to the 7th postoperative day the patients with high risk of DVT were decreased,and the patients with low and middle risk increased gradually.By Caprini rating scale,all of patients were rated as having high risk of VTE in the pre-operative period.4.When the scores of Autar and Caprini at point of 16.5 and 9.5,the sensitivity and specificity to diagnose DVT was 83.3%,81.9% and 50%,89.4%.The area under the ROC(AUC)of the Autar and Caprini rule was 0.887(95%CI:0.754-1)and 0.653(95%CI:0.384-0.923)Conclusion1.The Characteristics of TCM Syndrome of elderly patients with femoral neck fractures during pre-operative period usually transform from Sthenia syndrome to Asthenia syndrome,and the main TCM Syndrome expression is Sthenia syndrome.The Sthenia syndrome,Heat of excess syndrome and Insufficiency and excess syndrome have an higher risk of DVT.2.According to the change tendency of TEG,,the scores of Autar and Caprini.The elderly patients with femoral neck fractures have a higher incidence of DVT in the 1th day after hospitalized and in the 1th day after surgery compared to the day in the 3th and 7th day after surgery.It is necessary to strengthen the prevention and screening of DVT in this period.3.The prediction capacity for DVT,which the Autar rule perform better than the Caprini rule.4.The earlier walk,which can reduce the scores of Autar and reduve the incidence rate of DVT.