利伐沙班在人工关节置换术后深静脉血栓预防中的药理分析与临床应用研究

Pharmacological analysis and clinical application research of rivaroxaban in prevention of deep venous thrombosis after artificial joint replacement

目的总结利伐沙班的药理作用,比较利伐沙班和低分子肝素钙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 110例人工髋、膝关节置换术患者,将其随机分为观察组和对照组,术前彩色多普勒超声筛检,双下肢无深静脉血栓,观察组50例术后采用利伐沙班治疗,对照组60例采用低分子肝素钙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的发生情况,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)。结论人工关节置换术预防应用利伐沙班比预防应用低分子肝素钙明显降低了深静脉血栓发生率,值得临床广泛应用。

Objective To summarize pharmacological effect of rivaroxaban, and to compare clinical effects between rivaroxaban and low molecular weight heparin calcium in prevention of deep venous thrombosis（DVT） after joint replacement. Methods A total of 110 artificial hip joint and knee joint replacement patients were randomly divided into observation group and control group. Both groups received preoperative color Doppler ultrasound screening, which showed no DVT in both lower limbs. The observation group with 50 cases received rivaroxaban for treatment, and the control group with 60 cases received low molecular weight heparin calcium for anticoagulation. In 1 week after treatment, color Doppler ultrasound was applied to detect blood flow condition and DVT in lower limbs. Comparison was made on occurrence of DVT between the two groups after receiving artificial joint replacement. Results Color Doppler ultrasound was applied for the 110 cases in 1 week after operation. There were 27 cases（24.5%） with DVT. Incidence of DVT was 18%（9 cases） in the observation group, and 30%（18 cases） in the control group. Their difference had statistical significance（P〈0.05）. Conclusion Preventive implement of rivaroxaban in artificial joint replacement provides obviously lower incidence of DVT than low molecular weight heparin calcium, and it is worthy of widely clinical application.