磺达肝癸钠联合足底静脉泵预防髋、膝关节置换术后下肢深静脉血栓形成

Combination of fondaparinux sodium and plantar venous pump in prevention of deep venous thrombosis after knee or hip joints replace ment surgery

目的探讨磺达肝癸钠联合足底静脉泵预防髋、膝关节置换患者术后下肢深静脉血栓形成的有效性和安全性。方法根据入选标准选择133例连续的行人工髋、膝关节置换手术患者,随机分为三组:低分子肝素组45例、磺达肝癸钠组43例、磺达肝癸钠+足底静脉泵组44例,分别给予低分子肝素、磺达肝癸钠、磺达肝癸钠联合足底静脉泵预防深静脉血栓。结果三组患者总失血量、血小板、凝血酶原时间及活动度与活化部分凝血酶时间变化比较均无统计学差异(P>0.05);低分子肝素组、磺达肝癸钠组患者术后下肢DVT发生率分别为11.11%(5/45)、9.30%(4/43),差异无统计学意义(χ2=0.078,P>0.05),磺达肝癸钠+足底静脉泵组无1例发生深静脉血栓,与前两组比较均有统计学差异(χ2=4.29,P=0.038;χ2=5.18,P=0.023)。结论使用磺达肝癸钠预防髋、膝关节置换术后DVT的形成是安全有效的,联合足底静脉泵能够提高预防效果,比单独药物预防更加有效。

Objective To evaluate the safety and effectiveness of combination of fondaparinux sodium （FPX） and plantar venous pump （VP） in prevention of deep venous thrombosis after knee or hip arthroplasty. Methods 133 patients underwent primary knee or hip arthoplasty were divided into 3 groups randomly： LMWH group （45 patients, using low molecular weight heparin （LMWH））, FPX group （43 patiens, using FPX） and FPX＋ VP group （44 patients, using FPX and VP）. Results There was no statistically different（P〉0.05） in the total blood loss, platelets, prothrombin time （PT）,PTA,APTT and INR in three groups; In LMWH group, FPX group, the incidence of deep venous thrombosis was 11.11% （5145）, 9.30% （4/43） respectively, the difference was not statistically significant （xZ=0.078, P〉0.05）. No deep venous thrombosis oceured in FPX＋VP group, the difference was significant （X2=4.29,P=0.038; X2=5.18,P=0.023）. Conclusion Fondaparinux sodium can effectively and securely reduce the incidence of DVT after joint arthroplasty in patients. In the early post-operative phase after total hip or total knee replacement, combined prophylaxis with fondaparinux sodium and plantar venous pump is more effective than a single drug prevention.