利伐沙班预防骨科术后深静脉血栓及其对血液流变学的影响研究

Effect of Rivaroxaban on prevention of deep vein thrombosis and blood rheology after orthopedic surgery

背景:骨科术后易发生深静脉血栓(DVT),临床多给予低分子肝素等抗凝血药物,但效果并不理想。目的:研究利伐沙班预防骨科术后深静脉血栓(DVT)及其对血液流变学(BR)的影响。方法:选择2014年7月至2017年6月行骨科手术治疗的患者128例,依照随机数字表法分为未应用利伐沙班的对照组和应用利伐沙班的研究组各64例。观察两组术后6个月的DVT发生情况;术后1 d及术后7 d的血浆黏度(PV)、全血低切黏度(WBLSV)、全血高切黏度(WBHSV)、红细胞比容(Hct)及红细胞最大聚集指数(MAXD)等血液流变学(BR)指标;术后1 d及术后7 d的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)等炎性因子;出血事件等指标。结果:术后6个月,研究组的DVT发生率(7.8%)低于对照组(21.9%)(P<0.05)。术后7 d,两组的PV、WBLSV、WBHSV、Hct及MAXD等BR指标均较术后1 d降低,研究组的PV、WBLSV、WBHSV、Hct及MAXD等BR指标均低于对照组(P<0.05)。术后7 d,两组IL-6、IL-8、TNF-α等炎性因子均较术后1 d降低,研究组的IL-6、IL-8、TNF-α等炎性因子均低于对照组(P<0.05)。出血事件发生率研究组(10.9%)与对照组(9.4%)比较无统计学差异(P>0.05)。结论:利伐沙班可有效改善骨科手术患者的BR、炎性因子等指标,降低DVT发生率,且不增加出血事件发生率,值得临床推荐。

Background: Deep vein thrombosis(DVT) often occurs after orthopedic surgery. Low molecular weight heparin andother anticoagulants are often given clinically, but the effect is not satisfactory. Objective:To study the effect of Rivaroxaban inpreventing postoperative DVT and on blood rheology(BR). Methods: A total of 128 patients undergoing orthopedic surgery inour hospital from July 2014 to June 2017 were enrolled and divided into two groups according to the random number table as Ri-varoxaban group and control group, 64 patients in each. DVT occurrence 6 months after the surgery, BR indexes including plas-ma viscosity(PV), low blood viscosity(WBLSV), whole blood viscosity(WBHSV), hematocrit(Hct) and erythrocyte maximal ag-gregation index(MAXD), inflammatory factors including interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factoralpha(TNF-alpha) 1 and 7 days after the surgery, and bleeding event were collected. Results: 6 months after the surgery, the in-cidence of DVT was lower in the Rivaroxaban group(7.8%) than in the control group(21.9%, P<0.05). At 7 days after the sur-gery, PV, WBLSV, WBHSV, H and MAXD decreased in both groups compared with those at 1 day after the surgery, and those in-dexes were lower in the Rivaroxaban group than in the control group(P<0.05). 7 days after the surgery, IL-6, IL-8, and TNF-αdecreased in both groups compared with those at 1 day after the surgery, and those were lower in the Rivaroxaban group than inthe control group(P<0.05). The incidences of bleeding event were 10.9% and 9.4% in the Rivaroxaban group and control group,and there was no statistically significant difference(P >0.05). Conclusions: Rivaroxaban can effectively improve the blood rheol-ogy and inflammatory factors in patients receiving orthopedic surgery, reduce the incidence of DVT, and not increase the inci-dence of bleeding event, which is worthy of being recommended in clinical practice.