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例1,男,79岁,因右股骨颈骨折入院。患者在接受全髋关节置换术前1天晚开始给予低分子肝素钙3075U皮下注射。术后给予头孢噻肟钠、七叶皂甙钠、奥美拉唑,并插管引流。术后第3天拔除引流管,之后2h内引流口流出总量达400ml的血色液体。凝血试验示:PT14.6s,APTT54.7s,TT13.7s,纤维蛋白原3.2g/L,抗凝血酶原Ⅲ68.6s。血常规示:Hb76g/L,PLT188×109/L。立即肌内注射血凝酶1000U,6h后再注射1000U,并输新鲜血浆800ml,红细胞悬液5U。术后第3天停用低分子肝素钙,次日复查凝血试验依然正常,伤口未再出现渗血。例2,74岁女性患者因右股骨颈骨折入院。全髋关节置换术前12h,给予低分子肝素钙3075U皮下注射。手术过程中患者渗血较多,凝血试验示:APTT58.7s。立即给予鱼精蛋白30mg静脉注射,血凝酶1000U肌内注射。术后停用低分子肝素钙。术后第2天患者伤口未出现明显渗血。
Example 1, male, 79 years old, was admitted for a right femoral neck fracture. Patients underwent total hip arthroplasty 1 day before starting low molecular weight heparin 3075U subcutaneous injection. After cefotaxime sodium, aescinate, omeprazole, and catheter drainage. Drainage tube was removed on the third postoperative day, and a total of 400 ml of bloody fluid was flowed out of the drainage outlet within 2 hours after the operation. Coagulation test showed: PT14.6s, APTT54.7s, TT13.7s, fibrinogen3.2g / L, antithrombin Ⅲ68.6s. Blood showed: Hb76g / L, PLT188 × 109 / L. Immediate intramuscular injection of hemagglutinin 1000U, 6h and then injected 1000U, and lose fresh plasma 800ml, erythrocyte suspension 5U. Low-molecular-weight heparin was stopped on the third day after operation. The coagulation test was still normal on the next day and the bleeding did not recur. Example 2,74-year-old female patient admitted to the hospital for a right femoral neck fracture. Total hip replacement 12h, given low molecular weight heparin 3075U subcutaneous injection. Patients with bleeding during surgery more clotting test showed: APTT58.7s. Immediately given protamine 30mg intravenously, hemagglutinin 1000U intramuscular injection. Postoperative disable low molecular weight heparin. On the second day after operation, there was no obvious bleeding in the wounds.