不同抗凝药物对全膝关节置换术后失血量的影响

The impact of rivaroxaban and nadroparin on the blood loss after total knee arthroplasty

[目的]对比利伐沙班和那曲肝素对人工膝关节表面置换术(TKA)术后失血量的影响。[方法]接受初次单侧TKA手术的骨性关节炎患者79例,随机分为利伐沙班组(n=53)和那曲肝素组(n=26)。记录术后切口总引流量、自体血回输量和异体血输血量。测量术前及术后1、3、5 d血常规,通过Gross方程计算TKA术后隐性失血量和总失血量。[结果]利伐沙班组总引流量、回输量分别为(784.34±367.78)ml,(561.89±305.86)ml,与那曲肝素组相当[引流量和回输量分别为(713.46±356.94)ml和(479.62±259.85)ml,P=0.42和0.24]。术后5 d利伐沙班组Hb为(90.68±11.89)g/L,显著低于那曲肝素组(98.77±12.01 g/L,P=0.01)。两种抗凝药的应用对于患者术前、术后1、3、5 d的Hb及Hct总体的影响均不具备组间统计学差异(P>0.05)。隐性失血量、总失血量分别为(1 361.46±601.01)ml,(2 207.40±651.95)ml,与那曲肝素组相当[隐性失血量、总失血量分别为(1135.01±755.35)ml,(1 917.09±811.30)ml;P=0.15,P=0.09]。异体血输注率54.72%,输血量(307.55±329.25)ml,与那曲肝素组均无组间显著性差异(异体血输血率38.46%,输血量[(230.77±323.44)ml,P=0.17和P=0.28)]。[结论]相对于那曲肝素,利伐沙班并不增加术后失血量和异体血输血率。

[ Objective ] To compare the impact of rivaroxaban and nadroparin administration on blood loss after total knee arthroplasty （TKA） . [ Methods ] Seventy - nine patients with a primary diagnosis of osteoarthritis received unilateral TKA were randomly assigned into rivaroxaban group （ n = 53 ） and nadroparin group （ n = 26） . The volume of postoperative drainage, the amount of allogeneic blood and autotransfusion blood were recorded. Blood routine examination was performed on the 1 st, 3rd, and 5th day postoperatively. Then ti/e hidden blood loss and the total blood loss were calculated via Gross formula. [ Results ] The drainage and the volume of autologous blood transfusion of the rivaroxaban group were comparable to those of the nadroparin group （784. 34 ± 367. 78 ml vs. 713.46 ± 356. 94 ml, P = 0. 42; 561.89 ± 305.86 ml vs. 479. 62 ± 259. 85 ml, P = 0. 24）. On the 5＇h day postoperatively, Hb level of the rivaroxaban group was significantly lower than that of nadroparin group （90. 68 ± 11.89 g/L vs. 98. 77 ± 12.01 g/L, P =0. 01 ） . There was no significant difference between the two groups regards the Hb and Het before the surgery as well as on the Ist, 3ra, and 5＇h day postoperatively （P 〉0. 05） . The hidden blood loss and total blood loss of the rivaroxaban group were comparable to those of the nadroparin group （ 1 361.46 ± 601.01 ml vs. 1 135.01 ± 755.35 ml, P = 0. 15; 2 207.40 ± 651.95 ml vs. 1 917.09 ± 811.30 ml, P = 0. 09 ） . The rate of allogeneie blood transfusion and blood transfusion volume of rivaroxaban group were comparable to those of nadroparin group （54. 72% vs. 38.46%, P =0. 28; 307. 55 ＋ 329. 25 ml vs. 230. 77 ± 323.44 ml, P = 0. 17） . [ Conclusion ] There is no significant difference between the rivar- oxaban group and the nadroparin group regrading the postoperative blood loss and the rate of allogeneic blood transfusion after to- tal knee arthroplasty.