阿司匹林低分子肝素钠利伐沙班预防膝关节置换术后下肢深静脉血栓形成研究

Study of Aspirin Low Molecular Weight Heparin Sodium and Rivashaban in the Prevention of Deep Venous Thrombosis of Lower Extremity after Knee Arthroplasty

目的:探究膝关节置换术后,阿司匹林、低分子肝素钠、利伐沙班三种抗凝药物对患者下肢深静脉血栓预防效果的差异。方法:选择2017年7月至2019年4月来我院接受膝关节置换术治疗的200例患者作为研究对象,采用随机数字表法将患者分为甲乙丙三组,在膝关节置换术治疗12h后,甲组患者给予口服利伐沙班,乙组给予口服阿司匹林,丙组给予低分子肝素钠注射治疗。观察并对比三组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体数值和血小板值(Plt)等指标,记录下肢深静脉血栓发生率的差异。结果:抗凝后,甲组患者的有效治疗例数(66例)明显高于乙组(44例,68.75%)、丙组(47例,71.21%),总有效治疗率为94.29%,三者差异显著(P<0.05);甲乙丙三组的PT、APTT、Plt指标两两比较,甲乙组、乙丙组的三项指标无明显差异(P>0.05),甲丙组的三项指标差异明显(P<0.05);治疗后1d、1周、15d后,甲组D-二聚体数值明显低于丙组(P<0.05);治疗后1周、15d后,甲组D-二聚体数值明显低于乙组(P<0.05);术后甲组患者出现2例DVT,发生率为5.88%;乙组出现6例,发生率17.65%;丙组出现10例,发生率29.4%。甲乙(χ^2=2.267,P=0.132)与乙丙(DVTχ^2=1.308,P=0.253,)两两相比,无明显差异;甲丙(DVT发生率,χ^2=6.476)两组相比,二者差异显著(P<0.05)。结论:与低分子肝素相比,阿司匹林的疗安全性能更高,但对治疗效果的提高作用更低;利伐沙班的抗凝效果更高,但隐性失血量及切口并发症发生率较高。因此,可根据患者实际情况的抗凝需求合理选择。

Objective:To investigate the preventive effect of aspirin,low molecular weight heparin sodium and rivashaban on deep venous thrombosis of lower extremity after knee arthroplasty.Methods:200 patients with total knee replacement in our hospital from July 2017 to April 2019 were selected as the subject of the study.The patients with the group A were given an oral rivasahan treatment,and the povtients in group B was given an oral aspirin,and the group C was given low molecular heparin sodium injection treatment.The prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer and platelet value(Plt)were observed and compared among the three groups,and the incidence of deep venous thrombosis of lower extremity was recorded.Results:After anticoagulation,the number of effective treatment cases in group A(66 cases)was significantly higher than that in group B(44 cases,68.75%)and group C(47 cases,71.21%).The total effective treatment rate was 94.29%,with a significant difference(P<0.05);There was no significant difference in Pt,APTT and PLT indexes between group A and group B(P>0.05),and there was significant difference in three indexes between group A and group C(P<0.05);One day,one week and 15 days after the treatment,the D-dimer value of group A was significantly lower than that of group B(P<0.05);one week and 15 days after the treatment,the D-dimer value of group A was significantly lower than that of group C(P<0.05);two patients in group A had DVT,the incidence was 5.88%;six patients in group B,the incidence was 17.65%;ten patients in group C,the incidence was 29.4%.There was no significant difference between the two groups(χ^2=2.267,P=0.132)and the two groups(DVTχ^2=1.308,P=0.253,P=0.253,P<0.05).Conclusion:Compared with low molecular weight heparin,aspirin has a higher therapeutic safety,but a lower therapeutic effect;rivaroxaban has a higher anticoagulant effect,but a higher incidence of occult blood loss and incision complications.Therefore,the anticoagulation needs of patients can be reasonably selected according to the actual situation.