性别差异并不影响行全膝关节置换术患者的凝血功能障碍：一项血栓弹力图回顾性分析。
Gender Differences do not Influence the Blood Coagulopathy in Patients Undergoing Total Knee Arthroplasty: A Retrospective Thromboelastography Analysis.
机构信息
Department of Orthopaedics, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
Department of Orthopaedics, 36613Zhujiang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
出版信息
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211055716. doi: 10.1177/10760296211055716.
OBJECTIVE
Deep vein thrombosis (DVT) is one of the severe complications after total knee arthroplasty (TKA). Gender has been considered to influence the incidence of the thrombosis formation in TKA patients. However, it remains controversial which gender would be more prone to form thrombosis. The aim of this study was to assess the effects of gender differences on coagulation status after TKA via the thromboelastography (TEG).
METHODS
A total of 57 male patients who underwent primary TKA from September 2015 to January 2021 were included in this study. According to the matching principle of age, body mass index (BMI), and anticoagulation treatment, 60 female patients were selected. The conventional coagulation tests, routine blood tests, and thromboelastography were conducted before the operation, 1 day and 7 days after the operation. In addition, Doppler ultrasound was also performed 1 day before the operation and at the 7 days after the operation. The parameters of conventional coagulation tests, routine blood tests, and thromboelastography were compared between the two groups.
RESULTS
There were no significant differences in the blood transfusion rate, the incidence of DVT during the perioperative period, D-dimer (D-D), fibrin degradation products (FDP), hemoglobin (HB), hematocrit (HCT), prothrombin time (PT), activated partial thromboplastin time (APTT), and C-reactive protein (CRP) at any corresponding time point between the male group and the female group ( > .05). There were no significant differences in neutrophil-to-lymphocyte ratio (NLR) preoperatively; however, there were significant differences in NLR 1 day after the surgery and 7 days after the surgery between the two groups (< .05). There were significant differences in reaction time (R) and α angle 1 day after the surgery between the two groups ( < .05), but there were no significant differences in other TEG indexes at any corresponding time point between the two groups (> .05). Binary logistic regression analysis demonstrated that gender, age BMI, tourniquet application time were not independent predictors ( > .05).
CONCLUSION
Gender differences have no significant influence in TKA patients with regard to conventional coagulation tests and thromboelastography.
目的
深静脉血栓形成（DVT）是全膝关节置换术（TKA）后严重的并发症之一。性别被认为会影响 TKA 患者血栓形成的发生率。然而，哪种性别更容易形成血栓仍存在争议。本研究旨在通过血栓弹性图（TEG）评估性别差异对 TKA 后凝血状态的影响。
方法
本研究纳入了 2015 年 9 月至 2021 年 1 月期间接受初次 TKA 的 57 例男性患者。根据年龄、体重指数（BMI）和抗凝治疗的匹配原则，选择了 60 例女性患者。在手术前、手术后 1 天和 7 天进行了常规凝血试验、常规血液检查和血栓弹性图检查。此外，还在手术前 1 天和手术后 7 天进行了多普勒超声检查。比较了两组患者的常规凝血试验、常规血液检查和血栓弹性图参数。
结果
两组患者的输血率、围手术期 DVT 发生率、D-二聚体（D-D）、纤维蛋白降解产物（FDP）、血红蛋白（HB）、血细胞比容（HCT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和 C 反应蛋白（CRP）在任何相应时间点均无统计学差异（>0.05）。两组患者术前中性粒细胞与淋巴细胞比值（NLR）无统计学差异；然而，术后 1 天和术后 7 天两组 NLR 有统计学差异（<0.05）。两组患者术后 1 天的反应时间（R）和α角有统计学差异（<0.05），但在任何相应时间点两组的其他 TEG 指标均无统计学差异（>0.05）。二元逻辑回归分析表明，性别、年龄、BMI、止血带应用时间不是独立的预测因素（>0.05）。
结论
性别差异对 TKA 患者的常规凝血试验和血栓弹性图无显著影响。
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