利伐沙班与依诺肝素钠对髋膝关节置换术后下肢深静脉血栓形成及围手术期隐性失血的影响

Influence of rivaroxaban versus enoxaparin sodium on lower extremity deep venous thrombosis and perioperative recessive blood loss after hip and knee joint replacement

目的探讨利伐沙班与依诺肝素钠对髋膝关节置换术(HKJR)后下肢深静脉血栓形成及围手术期隐性失血的影响。方法选择2013年9月至2015年8月在我院骨科进行HKJR手术治疗的关节置换患者350例进行研究。根据简单数字随机表法将患者分为观察组和对照组,每组175例,两组患者均常规进行手术治疗,术后观察组给予利伐沙班治疗,而对照组给予依诺肝素钠治疗,在治疗14 d后比较两组患者的失血情况,以及血小板(PLT)、活化部分凝血活酶时间(APTT)及D-二聚体(D-D)水平,随访12个月后比较两组的血栓发生率。结果观察组患者的隐性失血量和总失血量分别为(584.33±210.27)m L和(1 506.37±317.84)m L,均明显大于对照组的(396.28±183.45)m L和(1 265.29±320.52)m L,差异均有统计学意义(P<0.05);两组患者治疗前后的Plt、APTT及D-D水平比较,差异均无统计学意义(P>0.05);根据Kaplan-Meier曲线分析可知,观察组患者随访12个月的血栓发生率为5.16%,明显低于对照组的10.94%,差异有统计学意义(P<0.05)。结论利伐沙班对髋膝关节置换术围术期造成的术后下肢深静脉血栓发生率更低,虽然隐性失血较依诺肝素钠较高,但二者对凝血功能的影响不大,值得重视。

Objective To discuss the influence of rivaroxaban versus enoxaparin sodium on lower extremity deep venous thrombosis and perioperative recessive blood loss after hip and knee joint replacement（HKJR）. Methods From September 2013 to August 2015, 350 patients who underwent HKJR in our hospital were studied. The patients were divided into the observation group and the control group according to random number table, with 175 cases in each group.All the patients received conventional surgical treatment. After surgery, the patients in the observation group were given rivaroxaban, while the patients in the control group were given enoxaparin sodium, for 14 days. The blood loss, platelet（PLT）, activation partial thromboplastin time（APTT）, D-dimer（D-D） levels, and the incidence of thrombosis were compared between the two groups after 12 months of follow-up. Results The recessive blood loss and total blood loss of the observation group were（584.33 ± 210.27） m L and（1 506.37 ± 317.84） m L, which were significantly greater than（396.28±183.45） m L and（1 265.29±320.52） m L in the control group, P〈0.05. There was no significant difference in the levels of D-D, APTT and PLT between the two groups before and after treatment（P〉0.05）. According to Kaplan-Meier curve, the incidence of thrombosis during 12 months of follow-up in the observation group was 5.16%, which was significantly lower than 10.94% in the control group（P〈0.05）. Conclusion Rivaroxaban results in lower extremity deep venous thrombosis rate after hip and knee joint replacement and greater perioperative recessive blood loss, compared with enoxaparin sodium, but the influence on blood coagulation function is not significant.