吲哚布芬预防老年髋关节置换术后下肢深静脉血栓的临床研究

Clinical study of indolbufen in preventing deep vein thrombosis of lower extremity after hip arthroplasty in elderly patients

目的探讨吲哚布芬预防老年患者髋关节置换术后下肢深静脉血栓(DVT)的疗效及安全性。方法前瞻性收集河北医科大学第三医院骨病科2017年1月至2017年8月因非外伤性原因行初次全髋关节置换的60岁以上患者100例。随机将100例患者分为两组,A组(50例)采用吲哚布芬200 mg,2/日抗凝治疗,B组(50例)采用利伐沙班10 mg,1/日抗凝治疗,两组抗凝药使用均不少于35 d,观察并对比两组血栓发生率、失血量及凝血功能等指标。结果 100例中共发生13例DVT,A组6例(12%)术后发生静脉血栓:肌间静脉血栓4例,胫后/腓静脉血栓2例。B组7例(14%)术后发生静脉血栓:肌间静脉血栓5例,胫后/腓静脉血栓2例。两组均未出现腘静脉及腘静脉以上严重血栓。A组和B组下肢DVT发生情况比较,差异无统计学意义(X^2=0.123,P=0.941)。两组患者术后1 d引流量均比2 d多,差异有统计学意义(A组:t=41.901,P<0.05;B组:t=31.185,P<0.05);两组患者术前血红蛋白均正常,术后1 d下降,术后7 d基本和术后1 d持平,组内不同时点间血红蛋白差异有统计学意义(F=17.688,P<0.001),两组间各时间点血红蛋白差异无统计学意义(F=0.724,P=0.399)。两组PT、APTT和INR术后呈上下波动,组内不同时点间差异有统计学意义(F=10.635,P<0.001;F=5.020,P=0.008;F=9.147,P<0.001);两组FIB、D-Dimmer也呈上下波动,组间(F=4.414,P=0.041;F=11.867,P<0.001)及组内不同时点间(F=88.996,P<0.001;F=103.021,P<0.001)差异均有统计学意义。结论与利伐沙班相比,吲哚布芬预防老年患者髋关节置换术后下肢DVT发生率相似,不显著增加患者的术后失血。

Objective To discuss the efficacy and safety of indolbufen in prevention of deep venous thrombosis after hip arthroplasty in elderly patients. Methods A total of 100 tramatic patients who underwent primary total hip arthroplasty from January 2017 to August 2017 in the department of orthopedics, the third hospital of hebei medical university were collected. 100 patients were randomly divided into two groups: group A(50 cases) was treated with 200 mg of indolebufen, 2/d, and group B(50 cases) was treated with 10 mg of rivaroxaban and 1/d anticoagulant. Anticoagulants were used for at least 35 days in both groups. We observed and compared the incidence of thrombosis, blood loss and coagulation function between the two groups. Results There were 13 DVT in 100 cases. In group A, 6 cases(12%) had postoperative venous thrombosis, 4 cases had intramuscular venous thrombosis, and 2 cases had posterior tibial/peroneal venous thrombosis. In group B, 7 cases(14%) had postoperative venous thrombosis, 5 cases had intramuscular venous thrombosis, and 2 cases had posterior tibial/peroneal venous thrombosis. No serious popliteal vein or femoral vein thrombosis occurred in either group. There was no statistically significant difference between group A and group B in the incidence of lower extremity deep vein thrombosis(X^2=0.123, P=0.941).The drainage of patients in both groups was higher on day 1 after surgery than that on day 2 after surgery,and the difference between the drainage on day 1 after surgery and that on day 2 after surgery was statistically significant(group A: t=41.901, P<0.05;Group B: t= 31.185, P<0.05);Patients in both groups had normal preoperative hemoglobin, decreased hemoglobin on the first day after surgery, and almost equal hemoglobin on the seventh day after surgery and the first day after surgery. There was statistically significant difference in hemoglobin between the two groups at different time points(F=17.688, P<0.001). There was no statistically significant difference in hemoglobin between the two groups at different time points(F=0.724, P=0.399).Postoperative PT, APTT and INR of the two groups fluctuated up and down, with only statistical difference in time points(F=10.635, P<0.001;F=5.020, P=0.008;F=9.147, P<0.001). FIB and d-dimmer also fluctuated up and down in the two groups, and there were statistical differences between the groups(F=4.414, P=0.041;F=11.867, P<0.001) and between the time points(F=88.996, P<0.001;F=103.021, P<0.001).Conclusion Compared with rivaroxaban, the incidence of deep vein thrombosis in lower extremities after hip arthroplasty was similar in indobufen prevention in elderly patients, with no significant increase in postoperative blood loss.