不同剂量利伐沙班对髋关节置换术患者下肢深静脉血栓、凝血功能的影响比较

Comparison of effects of different doses of rivaroxaban on deep venous thrombosis and coagulation function in patients with hip arthroplasty

目的探究不同剂量利伐沙班对髋关节置换术患者下肢深静脉血栓、凝血功能的影响,进而选取最为合适的应用剂量。方法选取2017年1月至2018年12月在该院进行髋关节置换术治疗的90例患者,将患者随机分为高、中、低剂量组,其利伐沙班给药剂量分别设定为20、15、10 mg/d,比较3组患者术前、术后1、7 d凝血功能指标、并对治疗期间患者发生DVT及其他不良反应情况进行比较。结果术前3组患者各项凝血功能差异均无统计学意义(P>0.05);术后,3组患者间PT、TT及APTT差异均无统计学意义(P>0.05),术后1、7 d,患者Fbg水平及D-D水平随着给药剂量的增加而逐渐降低,各组间差异均有统计学意义(P<0.05)。同时,随着给药时间的延长,3组患者Fbg水平均逐渐降低,D-D水平均逐渐升高,而PT指标在术后1 d达到最高值,在术后7 d时各组患者D-D指标均显著低于术后1 d(P<0.05),另外,高、中、低剂量组患者治疗期间发生DVT概率分别为3.33%、6.67%及16.67%,于低剂量组患者相比高、中剂量组DVT发生概率均显著较低(P<0.05),中、低剂量组患者不良反应发生率均为3.33%,显著低于高剂量组的13.33%(P<0.05)。结论采用利伐沙班对髋关节置换术患者进行干预,随着给药剂量的提高,能够更为有效的预防DVT的发生并降低患者凝血功能,但也可导致患者不良反应发生率的提高。

Objective To investigate the effects of different doses of rivaroxaban on deep venous thrombosis and coagulation function in patients with hip arthroplasty,and to select the most suitable dosage.Methods Ninety patients who underwent hip arthroplasty in the hospital from January 2017 to December 2018 were randomly divided into high,medium and low dose groups,the doses of rivaroxaban of three groups were set to 20 mg/d,15 mg/d and 10 mg/d,the coagulation function indexes of the three groups were compared before operation,1 d after operation and 7 d after operation,the DVT and other adverse reactions occurred during the treatment were analyzed.Results There were no significant differences in coagulation function between the three groups before operation(P>0.05).There was no significant difference in PT,TT and APTT between the three groups(P>0.05).And 7 d after the operation,the patient′s Fbg level and D-D level gradually decreased with the increase of the dose,there was significant difference between the groups(P<0.05).At the same time,with the prolongation of administration time,the Fbg levels of the three groups gradually decreased,and the D-D levels gradually increased.The PT index reached the highest value at 1 d after operation,and the D-D levels of each group were significantly lower at 7 d after operation(P<0.05).At 1d postoperatively,the incidences of DVT in the high,middle and low dose groups were 3.33%,6.67%and 16.67%,respectively.In the low dose group,DVT occurred in the high and middle dose groups.The odds were significantly lower(P<0.05),the incidence of adverse reactions in the middle and low dose groups was 3.33%,which was significantly lower than that of the dose group(13.33%)(P<0.05).Conclusion The intervention of rivaroxaban in patients with hip arthroplasty could effectively prevent the occurrence of DVT and reduce the coagulation function of patients with the increase of dose,but it can also lead to an increase in the incidence of adverse reactions.