利伐沙班在人工关节置换术后深静脉血栓预防中的应用研究

Application of Rivaroxaban in the prevention of deep venous thrombosis after artificial joint replacement

目的比较利伐沙班和低分子肝素对预防人工关节置换术后深静脉血栓(DVT)发生的临床效果。方法对110例人工髋、膝关节置换术的患者进行DVT的回顾性分析。110例患者术前行彩色多普勒超声筛检,双下肢无深静脉血栓,术后采用以利伐沙班(观察组,50例)或低分子肝素(对照组,60例)抗凝为主的综合预防措施,术后第1周用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生,对比观察两组患者人工关节置换术后深静脉血栓的发生情况。结果 110例患者在人工关节置换术后第1周行彩色多普勒超声检查,发现27例(24.5%)患者有深静脉血栓,观察组深静脉血栓的发生率为18%(9例),对照组为30%(18例),两组比较差异有统计学意义(P<0.05)。两组患者术前的血液流变学指标、血小板计数、凝血指标、D-二聚体、ET水平比较差异无统计学意义(P>0.05);术后第1天各项指标与术前比较差异有统计学意义(P<0.05);疗程结束后各项指标水平均较术后第1天明显降低,恢复至术前水平,差异具有统计学意义(P<0.05);疗程结束后观察组各项指标水平显著低于对照组,差异有统计学意义(P<0.05)。观察组和对照组切口引流量分别为325.62 m L和463.62 m L,观察组明显少于对照组,差异具有统计学意义(t=2.874,P<0.05)。观察组和对照组有出血倾向者分别为4例(8%)和12例(20.0%),观察组明显低于对照组,差异具有统计学意义(χ2=3.905,P<0.05)。两组均未发生严重过敏反应、肝肾功能损害等药物不良反应。结论人工关节置换术预防应用利伐沙班较预防应用低分子肝素明显降低了深静脉血栓发生。

Objective To compare the clinical effect of the treatment of deep venous thrombosis（ DVT） after artificial joint replacement with Rivaroxaban and Low Molecular Heparin heparin. Methods A retrospective analysis of 110 cases of artificial hip and knee replacement surgery in patients with DVT was carried out. 110 cases were tested with preoperative color Doppler ultrasound screening,and no deep vein thrombosis was found in both lower limbs. 50 cases were given Rivaroxaban（ observation group） and 60 cases received Low Molecular Heparin for anticoagulation（ control group） as comprehensive preventive measures after operation. The patients were given color Doppler examination of lower limbs to check the incidence of DVT and the blood flow in vein 1 week after the artificial joint replacement operation. The incidence of DVT was compared between the two groups of patients. Results Deep venous thrombosis were found in 27 patients（24. 5%）. The incidence rate of deep venous thrombosis was18%（9 cases） in observation group and 30%（ 18 cases） in control group and the difference between the two groups has statistical significance（ P〈0. 05）. There was no statistical difference in preoperative blood rheological indicators,platelet count,blood coagulation index,D-dimer and ET level between two groups of patients before the operation（ P〉0. 05）; there was statistical difference in each index 1 day after the operation（ P〈0. 05）; after the end of treatment,the level of each indicator was significantly lower compared to that of 1 day after the operation and restored to the preoperative level,and the difference has statistical significance（ P〈0. 05）. The index in the observation group was significantly lower than that of the control group at the end of the treatment（ P〈0. 05）. The incision drainage in observation group and the control group was respectively 325. 62 m L and 463. 62 m L） and the difference is statistically significant（ t = 2. 874,P〈0. 05）. There were 4 cases（8%） and 12 cases（20. 0%） of bleeding in observation group and the control group respectively and the difference is statistically significance（ χ2=3. 905,P 0. P05）. No adverse drug reactions such as severe allergic reactions,liver and kidney function damage and so on appeared. Conclusion Application of Rivaroxaban in artificial joint replacement has better preventive function than the application of Low Molecular in the prevention of the occurrence of deep venous thrombosis.