| Femoral neck fracture is a relatively common type of fracture in orthopaedics,with hip joint pain,inability to stand and walk as the main symptoms,accompanied by deformity,swelling,increased trochanter on the affected side and other signs.At present,hip replacement is the preferred treatment for most elderly patients with femoral neck fracture.However,complications such as nonunion of fracture,avascular necrosis of femoral head and venous thrombosis exist in the course of treatment and prognosis.Venous thrombosis can lead to venous insufficiency,disability or sudden death due to pulmonary embolism.Therefore,the prevention,control and treatment of venous thrombosis has always been a key research field in hip replacement patients.Venous thrombosis is a disorder of venous reflux,which is mainly related to slow blood flow,vascular damage and hypercoagulability.Hemorheological indexes mainly reflect blood viscosity and fluidity,including whole blood viscosity,plasma viscosity,erythrocyte sedimentation rate and hematocrit.Whole blood viscosity is an important index reflecting the degree of blood viscosity in hemorheological indicators.When blood viscosity increases,blood fluidity becomes worse,and thrombotic diseases are prone to occur.Preoperative abstinence from drinking and fasting can have a significant impact on blood viscosity of elderly patients,mainly manifested in increased blood viscosity,blood concentration,erythrocyte aggregation and blood coagulation.This study explored the prevention of the risk of deep venous thrombosis from the point of whole blood viscosity.At present,the correlation between liquid intake and whole blood viscosity is relatively rare.In this study,182 patients with femoral neck fracture undergoing total hip arthroplasty were selected as the research objects,to explore the correlation between fluid intake and blood viscosity,and to further analyze the influencing factors of abnormal blood viscosity,so as to provide an important reference for the prevention of deep venous thrombosis after hip arthroplasty.Objective:1.To investigate the correlation between fluid intake on the day of operation and whole blood viscosity in patients with femoral neck fracture undergoing hip replacement.2.To analyze the influencing factors of abnormal blood viscosity after hip replacement for femoral neck fracture and the correlation between high blood viscosity and the incidence of deep vein thrombosis.Research methods:This study is a cross-sectional study design.Using convenient sampling method,182 patients with femoral neck fracture who were admitted to the joint surgery department of a comprehensive third-class A hospital in Yangzhou from January 2018 to June 2019 were selected as the subjects of investigation.The survey content includes four parts:questionnaire survey,physical examination,laboratory examination and imaging examination.Questionnaire survey included self-designed "Patient General Situation Record Form","Patient Drinking Water and Diet Record Form","Intravenous Infusion Card" and "Patient Clinical Data Registration Form" to investigate the general situation of patients,the amount of drinking water and food water on the day of operation,intravenous infusion volume,operation time and intraoperative bleeding volume.Physical examination includes measuring height,weight and blood pressure.Laboratory examination included fasting whole blood viscosity,D-dimer content and coagulation at 6:00 on the first day after operation.The imaging examination was performed by Doppler ultrasound examination of deep veins of both lower extremities before and 1 days after operation.To explore the correlation between fluid intake(intravenous infusion plus drinking)and whole blood viscosity,and to further analyze the influencing factors of abnormal blood viscosity after operation,so as to provide an important reference for the prevention of deep venous thrombosis after hip replacement.Research results:1.Analysis of the correlation between fluid intake on the day of operation and whole blood viscosity in patients with femoral neck fracture undergoing hip arthroplasty showed that:fluid intake were negatively correlated with low shear rate of whole blood viscosity(ηb-Lγ),middle shear rate of whole blood viscosity(ηb-Mγ),and high shear rate of whole blood viscosity(_ηb-Hγ)(P<0.05).With the decrease of liquid intake,the whole blood viscosity increased.Further analysis of the correlation between intake,intravenous2.infusion and whole blood viscosity showed that intake was negatively correlated with whole blood viscosity,and with the decrease of intake,whole blood viscosity increased.3.The blood viscosity of patients after operation was divided into two groups:whole blood viscosity increasing group and non-whole blood viscosity increasing group.The distribution of D-dimer and coagulation four items in whole blood viscosity increasing group and non-whole blood viscosity increasing group after total hip arthroplasty was analyzed by t test.The results showed that the concentration of D-dimer and fibrinogen in whole blood viscosity increasing group was significantly higher than that in whole blood viscosity increasing group.(P<0.05).There was significant difference in the distribution of activated partial thromboplastin time between the two groups(P<0.05).There was no significant difference in prothrombin time and thrombin time between the two groups.The distribution of venous thrombosis in the two groups was analyzed by chi-square analysis.The results showed that there were 4 patients with venous thrombosis in the group with increased whole blood viscosity,which was significantly higher than that in the group without increased whole blood viscosity(P<0.05).3.In this study,the whole blood viscosity indexes of patients undergoing hip replacement were grouped,and the distribution differences of liquid intake,intravenous infusion volume,intake volume,operative time,bleeding volume,body mass index(BMI),age,gender and underlying diseases in different blood viscosity index groups were analyzed.The results showed that there was a significant difference in the distribution of sex in middle shear group of whole blood viscosity(P<0.05),and there was a significant difference in the distribution of liquid intake between the low shear group of whole blood viscosity and high shear group of whole blood viscosity(P<0.05).There were statistical differences in the distribution of intake,BMI index,operation time and hypertension in low shear group,middle shear group and high shear group of whole blood viscosity(P<0.05).There were statistical differences in the distribution of diabetes mellitus patients in different whole blood viscosity low shear groups(P<0.05).There were statistical differences in the distribution of coronary heart disease patients in different whole blood viscosity low shear groups and high shear groups(P<0.05).There were statistical differences in the distribution of age in different whole blood viscosity low shear groups(P<0.05).4.Logistic regression was used to analyze the relationship between the abnormal,low shear rate of blood viscosity,middle shear rate of blood viscosity and high shear rate of blood viscosity after hip arthroplasty and the sex,age,blood pressure,fluid intake,intravenous infusion and intake of the subjects.The results showed that factors related to high shear rate of blood viscosity and low shear rate of blood viscosity included operation time,fluid intake,intake,hypertension,diabetes mellitus and coronary heart disease.It is suggested that the risk of high low shear rate of blood viscosity in patients with hypertension,diabetes mellitus and coronary heart disease after operation is significantly higher than that in other patients;the longer the operation time,the higher the risk of high whole blood viscosity of low shear rate in patients after operation;and the higher the risk of high whole blood viscosity of low shear rate in patients with less liquid intake and intake.The factors related to high whole blood viscosity of mid-shear were operation time and intake.The results suggested that the longer the operation time,the higher the risk of high whole blood viscosity of mid-shear;the lower the intake,the higher the risk of high whole blood viscosity of mid-shear;the factors related to high whole blood viscosity of high shear were fluid intake,intake,operation time and coronary heart disease.It is suggested that the longer the operation time,the higher the risk of high shear rate of blood viscosity in patients after operation,the higher the risk of high whole blood viscosity of high shear rate in patients after operation with less liquid intake and drinking,and the higher the risk of high whole blood viscosity of high shear rate in patients with coronary heart disease after operation than in patients without coronary heart disease.The research conclusion:1.The whole blood viscosity index has an effect on the risk of venous thrombosis in patients undergoing hip replacement.The whole blood viscosity index increases and the risk of thrombosis increases.2.There is a significant negative correlation between fluid intake and whole blood viscosity after hip replacement for femoral neck fracture.The regression analysis results indicate that the decrease of fluid intake after hip replacement increases the risk of increased whole blood viscosity.It suggests that the nursing of fluid intake should be strengthened in the post-operative nursing of hip replacement patients,and patients should be encouraged to increase their intake to prevent high whole blood viscosity after operation.The occurrence of DVT can reduce the risk of DVT.3.Patients with hypertension,diabetes mellitus and coronary heart disease who underwent hip replacement have a higher risk of high blood viscosity.In the course of clinical treatment and nursing,we should pay close attention to the whole blood viscosity index,Strengthen the Nursing and Management of Liquid Intake,and take comprehensive measures to improve the whole blood viscosity and reduce the risk of deep venous thrombosis. |
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