利伐沙班和低分子量肝素钙在人工关节置换术后预防深静脉血栓形成的效果比较

Rivaroxaban and Low Molecular Weight Heparin Calcium to Prevent Deep Vein Thrombosis after Artificial Joint Replacement

目的观察利伐沙班与低分子量肝素钙预防人工关节置换术后深静脉血栓（DVT）形成的疗效。方法 2009年11月~2010年10月行膝关节置换及全髋置换的患者167例,其中全髋置换患者114例,膝关节置换患者53例。以患者住院时间顺序分为两组：利伐沙班组（n=84）：术后6 h内开始使用利伐沙班10 mg/d,1次/日,口服,膝关节置换术2周,全髋置换术5周。低分子量肝素钙组（n=83）：手术前2 h及手术后每天皮下注射低分子量肝素钙2500 IU,5 d。疗效评定：术前与术后行双下肢静脉超声,了解深静脉管腔大小改变、DVT发生率;凝血功能于实验开始前和治疗2 d、5 d、1周、2周、5周末各测定1次。结果①DVT发生率比较：利伐沙班组中有9例发生DVT（10.7%）;低分子量肝素钙组中有15例患者发生DVT（18.1%）。②下肢静脉管腔大小前后变化比较：股浅静脉狭窄〉2 mm者,利伐沙班组中有23例（27.4%）,低分子量肝素钙组中有38例（45.8%）;腘静脉狭窄〉2 mm者,利伐沙班组中有27例（32.1%）,低分子量肝素钙组中有47例（56.6%）,两者比较差异有统计学意义（P〈0.01）。③凝血功能检测：活化部分凝血活酶时间延长10 s以上者,利伐沙班组0例（0%）,低分子量肝素钙23例（27.7%）（P〈0.01）。结论利伐沙班在人工关节置换术后预防深静脉血栓形成较低分子量肝素钙效果更佳,且凝血功能几乎不受影响。

Objective To observe the effect of the rivaroxaban and low molecular weight heparin calcium to prevent deep vein thrombosis(DVT) after artificial joint replacement.Methods 167 patients included 114 cases for total hip arthroplasty and 53 cases for total knee replacement from Novermber,2009 to October,2010 were divided into two groups: observation group(n=84) was treated with rivaroxaban tablets,6 h after surgery,10 mg/d,2 weeks for knee arthroplasty,5 weeks for total hip arthroplasty;and control group(n=83) was treated with low molecular weight heparin calcium 2500 IU 2 h before and after surgery for 5 d.Ultrasonography was used to detect the deep vein lumen size change and DVT rate of bilateral lower extremities in all patients before and after surgery.Activated partial thromboplastin time(APTT) was tested before surgery,and 2 d,5 d,7 d,14 d,35 d after surgery.Results ① Incidence of DVT showed that there were 9 cases(10.7%) with DVT in the observation group;there were 15 cases with DVT(18.1%) in the control group.② Lower limb deep vein lumen size change comparison: there were 23 cases(27.4%) with superficial femoral vein stenosis more than 2 mm in the observation group while 38 cases(45.8%) in the control group,there were 27 cases(32.1%) with popliteal veins stenosis more than 2 mm in the observation group and 47 cases(56.6%) in the control group(P<0.01).③APTT: APTT prolonged >10 s was 0 in the observation group while 23 cases(27.7%) in the control group(P<0.01).Conclusion TRivaroxaban may prevent DVT after artificial joint replacement and be better than low molecular weight heparins calcium.