不同方法对全髋关节置换术后患者静脉血栓栓塞预防效果的比较

Comparison of the effects of different methods on prevention of venous thromboembolism in patients after total hip replacement

目的分析利伐沙班与低分子肝素预防全髋关节置换术后静脉血栓栓塞症(VTE)的临床效果。方法选择2011年2月至2015年4月本院择期接受全髋关节置换术的100例患者作为研究对象,随机分为A、B组各50例。A组口服利伐沙班预防术后VTE,B组采用注射低分子肝素作预防处理,监测两组术前、术后5周凝血指标凝血酶原时间(PT)、D-二聚体(D-D)、纤维蛋白原(FIB)水平的变化,检测血小板计数(PLT)及血红蛋白(Hb)水平的变化,测定两组股浅静脉内径、腘静脉内径的变化,统计VTE及不良反应发生率。结果术后5、8周,两组PT均延长,D-D、FIB上升,与同组术前比较差异有统计学意义(P<0.05),A组D-D、FIB上升幅度低于B组(P<0.05);两组Hb均降低,A组Hb降低幅度低于B组(P<0.05),PLT对比差异无统计学意义(P>0.05);两组股浅静脉内径无明显变化,A组腘静脉内径降低,明显低于同组术前及B组(P<0.05);A组DVT、PTE及总VTE发生率略低于B组,但差异无统计学意义(P>0.05);两组术后不良事件发生率对比差异无统计学意义(P>0.05)。结论采用利伐沙班预防全髋关节置换术后VTE,抗凝效果好,可降低VTE不良血事件发生率,安全性高。

Objective To analyze the clinical effect of rivaroxiban and low molecular weight heparin on the prevention of venous thromboembolism （VTE） after total hip replacement. Methods One hundred patients who underwent total hip replacement in our hospital between February 2011 and April 2015 were randomized into group A and group B, with 50 cases in each group. Group A was treated with oral administration of rivaroxiban while group B was treated with injection of low molecular weight heparin for prevention of postoperative VTE. The changes of prothrombin time （PT）, D-dimer （D-D） and fibrinogen （FIB） levels in the two groups were monitored before operation and 5 weeks after operation. Changes of platelet count （PLT） and hemoglobin （Hb） levels were detected. Changes of inner diameter of femoral superficial vein and inner diameter of popliteal vein were determined. The incidence of VTE and adverse reactions was statistically analyzed. Results Five and 8 weeks after operation,PT of both groups were prolonged, while FIB and D-D increased. Compared with those in the same group before operation, there were significant differences （P〈0.05）. The increasing amplitude of D-D and FIB in group A was lower than that in group B （P〈0.05）; Hb decreased in both groups, and the decreasing amplitude in group A was lower than that in group B （P〈0.05）. There was no significant difference in PLT between the two groups （P〉 0.05）. There were no significant changes of inner diameter of femoral superficial vein in the two groups. Inner diameter of popliteal vein decreased in group A and was significantly lower than that in the same group before operation and that in group B at 5 and 8 weeks after operation （P〈0.05）. The incidence rates of DYT, PTE and total incidence of VTE in group A tended to be lower than those in group B but the difference did not reach the level of statistical significance （P〉0.05）. There was no significant difference in of using rivaroxiban on the prevention of VTE after total hip replacement is favorable, and it can safely reduce the incidence of adverse events of YTE.