利伐沙班预防全膝关节置换术后下肢深静脉血栓临床效果评价

Effect of Rivaroxaban on Preventing Lower Excremity DVT After Total Knee Arthroplasty

目的探讨利伐沙班预防全膝关节置换术后下肢深静脉血栓(DVT)发生的效果。方法选取医院2017年3月至2019年3月收治拟行全膝关节置换术的患者134例,随机分为观察组和对照组,各67例。按体质量指数(BMI)水平观察组分为高BMI(≥25 kg/m^2)组(A1组,29例)、低BMI(<25 kg/m2)组(A2组,38例),对照组分为高BMI(≥25 kg/m^2)组(B1组,35例)、低BMI(<25 kg/m^2)组(B2组,32例)。4组患者均行全膝关节置换术,术后均进行翻身、按摩活动,并予低分子肝素钙注射液皮下注射,观察组患者术后加服利伐沙班片。4组患者均连续治疗1周。结果DVT发生率,A1组显著低于B1组(13.79%比25.71%),A2组显著低于B2组(2.63%比21.88%),A2组显著低于A1组(P<0.05);与治疗前比较,4组患者治疗后的D-二聚体(D-D)、纤维蛋白原(FIB)水平及高切全血黏度(HBV)、中切全血黏度(MBV)、低切全血黏度(LBV)水平均显著降低,活化部分凝血活酶时间(APTT)均显著延长,A1组和A2组上述指标改善程度分别显著优于B1组和B2组,且A2组显著优于A1组(P<0.05);4组不良反应发生率相当(P>0.05)。结论利伐沙班能降低全膝关节置换术后DVT发生率,改善凝血状态和血液流变学指标,且对低BMI患者的效果更好。

Objective To study the effect of rivaroxaban on preventing lower extremity deep venous thrombosis(DVT)in patients after total knee arthroplasty.Methods A total of 134 patients who underwent total knee arthroplasty in the hospital from March 2017 to March 2019 were selected and randomly divided into the observation group and control group,67 cases in each group.According to the size of body mass index(BMI),the observation group was divided into 29 cases of high BMI group(group A1,BMI≥25 kg/m^2)and 38 cases of low BMI group(group A2,BMI<25 kg/m^2).The control group was divided into 35 cases of high BMI group(group B1,BMI<25 kg/m^2)and 32 cases of low BMI group(group B2,BMI<25 kg/m^2).All patients underwent total knee arthroplasty,turning over and massage after operation,and low molecular weight heparin;the observation group was added with rivaroxaban tablets postoperatively.Both groups were continuously treated for 1 week.Results The incidence of DVT in group A1 was significantly lower than that in group B1(13.79%vs.25.71%),and group A2 was significantly lower than group B2(2.63%vs.21.88%);group A2 was significantly lower than group A1,and the differences were statistically significant(P<0.05).Compared with before treatment,the D-dimer(D-D)and fibrin,the original(FIB)level and high-cut whole blood viscosity(HBV),mid-cut whole blood viscosity(MBV),and low-cut whole blood viscosity(LBV)levels in the 4 groups were significantly reduced,and the activated partial thromboplastin time(APTT)was significantly prolonged;the improvement of the above indexes in group A1 and group A2 were significantly better than those in group B1 and group B2,respectively,and group A2 was significantly better than group A1(P<0.05);the incidence of adverse reactions was similar in the 4 groups(P>0.05).Conclusion Rivaroxaban can reduce the incidence of DVT after total knee arthroplasty,improve the coagulation state and hemorheology indexes,and has a better effect on patients with low BMI.