两种抗凝药物对人工全髋关节置换术隐性失血的影响比较

COMPARISON OF EFFECTS OF TWO ANTICOAGULANTS ON HIDDEN BLOOD LOSS AFTER TOTAL HIP ARTHROPLASTY

目的比较利伐沙班和依诺肝素钠对人工全髋关节置换术(total hip arthroplasty,THA)后隐性失血的影响。方法回顾分析2009年6月-2012年1月76例(93髋)因股骨头缺血性坏死接受初次THA患者的临床资料,其中44例(54髋)从术后6～10 h开始每天口服利伐沙班10 mg,连用14 d(利伐沙班组);32例(39髋)从术后12 h开始每日皮下注射依诺肝素钠4 000 U,连用14 d(依诺肝素钠组)。两组患者性别、年龄、身高、体重、病程、股骨头缺血性坏死分期及置换侧别等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。两组患者术前准备及术中处理均一致。比较两组围手术期实际失血总量、显性失血量、隐性失血量及隐性失血量占实际失血总量百分比;记录术后35 d内各组出血事件。结果利伐沙班组实际失血总量为(1 509.56±325.23)mL,显性失血量为(928.09±210.50)mL,隐性失血量为(581.47±215.01)mL,隐性失血量占实际失血总量百分比为37.88%±10.42%;依诺肝素钠组分别为(1 521.38±516.49)mL、(917.50±378.73)mL、(603.88±377.15)mL及38.18%±18.33%;两组以上各指标比较,差异均无统计学意义(P>0.05)。术后35 d内利伐沙班组出血事件发生率为9.1%(4/44),高于对照组的3.1%(1/32),但差异无统计学意义(χ2=1.073,P=0.390)。结论对于初次行THA的患者,围手术期使用利伐沙班与依诺肝素钠后隐性出血风险及出血事件发生率无显著差异。

Objective To compare the effects of rivaroxaban and enoxaparin on hidden blood loss after total hip arthroplasty （THA）. Methods A retrospective analysis was made on the clinical data of 76 patients （93 hips） with avascular necrosis of the femoral head who underwent primary THA between June 2009 and January 2012. After operation, 10 mg rivaroxaban was used at 6-10 hours for 14 days in 44 cases （54 hips） （rivaroxaban group） and 4 000 U enoxaparin at 12 hours for 14 days in 32 cases （39 hips） （enoxaparin group）. There was no significant difference in age, gender, weight, height, disease duration, grade of avascular necrosis of the femoral head, and lesion hips between 2 groups （P 〉 0.05）. The total blood loss, dominant blood loss, hidden blood loss, and percentage of hidden blood loss were calculated according to the formula. The bleeding events were recorded within 35 days after operation. Results The total blood loss was （1 509.56 ± 325.23） mL; the dominant blood loss was （928.09 ± 210.50） mL; the hidden blood loss was （581.47 ± 215.01） mL; and the percentage of hidden blood loss was 37.88% ±10.42% in the rivaroxaban group. The total blood loss was （1 521.38 ± 516.49） mL; the dominant blood loss was （917.50 ± 378.73） mL, the hidden blood loss was （603.88± 377.15） mL, and the percentage of hidden blood loss was 38.18%±18.33% in the enoxaparin group. There was no significant difference in the above indicators between 2 groups （P 〉 0.05）. The incidence of bleeding event was 9.1% （4/44） in the rivaroxaban group and was 3.1% （1/32） in the enoxaparin group, showing no significant difference （X2=1.073, P=0.390）. Conclusion There is no significant difference in the risk of hidden blood loss and incidence of bleeding event for primary THA between the rivaroxaban and the enoxaparin use.