利伐沙班预防骨科下肢大型手术后深静脉血栓的效果分析

Effect of rivaroxaban in preventing deep venous thrombosis after large orthopedic operation of lower extremity

目的探讨利伐沙班预防骨科下肢大型手术后深静脉血栓(DVT)的效果。方法选取80例下肢进行大型手术的患者,随机分为两组,对照组(39例)sc依诺肝素钠注射液,观察组(41例)口服利伐沙班。观察并记录两组患者血液动力学指标、DVT诊断指标、随访1个月期间并发症发生情况,评价利伐沙班预防骨科下肢大型手术后DVT的效果。结果术前,两组血小板计数、血红蛋白、血浆凝血酶原时间(PT)值相比,差异无统计学意义。与术前相比,术后3 d两组血小板计数、血红蛋白没有明显改变,PT值显著增加(P<0.05)。两组间血小板计数、血红蛋白相比,差异无统计学意义,但观察组PT值显著高于对照组(P<0.05);术后1 h,两组D-二聚体(D-dimer)、同型半胱氨酸(Hcy)和超敏-C反应蛋白(hs-CRP)值相比,差异无统计学意义。与术后1 h相比,术后3 d两组D-dimer、Hcy、hs-CRP值均明显下降且观察组上述指标均低于对照组(P<0.05);术后随访1个月,虽然两组各类并发症发生率相比,差异无统计学意义,但对照组在DVT、继发出血并发症发生率上高于观察组。结论利伐沙班对DVT形成具有较好的预防效果,适用于骨科下肢大型手术后的抗凝治疗,值得临床推广使用。

Objective To discuss the effect ofrivaroxaban in preventing deep venous thrombosis after large orthopedic operation of lower extremity. Methods Totally 80 patients after lower extremity of large orthopedic operation were selected, they were divided into two groups randomly. The patients in control group （39 cases） were sc injected with enoxaparin through. The patients in observation group （41 cases） were given rivaroxaban orally. The effect of rivaroxaban in preventing deep venous thrombosis after large orthopedic operation of lower extremity were evaluated by hemodynamic indexes, diagnosis index, and complications during 1 months follow-up. Results Before operation, there was no statistical significance on platelet, hemoglobin, and PT values between two groups. Compared with the value before operation, the value ofplatelet and hemoglobin had no significantly change after 3 d of operation. But the PT was increased （P 〈 0.05）. After 3 d of operation, there was no statistical significance on platelet and hemoglobin between two groups. But the PT value of observation was higher than that of control group （P 〈 0.05）. After 1 h operation, there was no statistical significance on D-dimer, Hey, and hs-CRP between two groups. Compared with the value after 1 h of operation, the values of D-dimer, Hey, and hs-CRP were decreased significantly （P 〈 0.05）. And the indexes of observation group were lower than those of control group （P 〈 0.05）. After 1 months of operation, although there was no statistical Significance on complications between two groups, the incidence rate of secondary bleeding and DVT of control group was higher than that of the observation group. Conclusion The rivaroxaban could prevent DVT well, which is suitable for the anticoagulation therapy after lower extremity of large orthopedic operation with little influence on platelet and hemoglobin. It is worthy of clinical application.