利伐沙班联合快速康复锻炼在全膝关节置换术中的应用效果

Effect of Rivaroxaban combined with rapid rehabilitation exercise in total knee arthroplasty

目的探讨利伐沙班联合快速康复锻炼在全膝关节置换术(TKA)中的应用效果。方法回顾性分析2016年5月~2019年11月南方医科大学深圳医院收治的73例行全膝关节置换术患者的临床资料,将39例术后进行了快速康复锻炼的患者设为研究组,将34例未进行快速康复锻炼的患者设为对照组。比较两组患者术后3 d以及术后7 d的凝血功能、抗凝血酶-Ⅲ(AT-Ⅲ)水平、D-二聚体(D-D)及下肢深静脉血栓(DVT)发生率。结果术前两组患者的D-D、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)及凝血酶原时间(PT)比较,差异无统计学意义(P>0.05);术后3 d两组患者下肢DVT发生率比较,差异无统计学意义(P>0.05);术后7 d的研究组患者下肢DVT发生率低于对照组,差异有统计学意义(P<0.05);术后3 d两组患者的D-D、TT、APTT、PT、AT-Ⅲ水平比较,差异无统计学意义(P>0.05);术后7 d的研究组患者D-D水平低于对照组,差异有统计学意义(P<0.05);术后7 d的研究组AT-Ⅲ水平高于对照组,差异有统计学意义(P<0.05);术后7 d两组患者的TT、APTT、PT水平比较,差异无统计学意义(P>0.05)。结论术后服用利伐沙班联合快速康复锻炼能有效降低术后D-D水平,提高血液流通速度,从而能有效预防全膝关节置换术后DVT形成,且对凝血功能影响不大,临床应用安全,可在临床上广泛应用。

Objective To explore the effect of Rivaroxaban combined with rapid rehabilitation exercise in total knee arthroplasty(TKA).Methods The chinical data of 73 patients with total knee arthroplasty who were treated in the orthopaedic department of Shenzhen Hospital of Southern Medical University from May 2016 to November 2019 were restrospectively analyzed.A total of 39 patients with rapid rehabilitation exercise were enrolled in the study group,another 34 patients without rapid rehabilitation exercise were enrolled in the control group.The coagulation function,antithrombin-Ⅲ(AT-Ⅲ)level,D-dimer(D-D)and the incidence of deep vein thrombosis(DVT)in lower limbs at 3 and 7 days after operation of the patients in the two groups were compared.Results There were no significant differences in D-D,thrombin time(TT),activated partial thromboplastin time(APTT)and prothrombin time(PT)between the two groups before operation(P>0.05).There was no significant difference in the incidence of lower limbs DVT between the two groups at 3 days after operation(P>0.05).The incidence of DVT in lower limbs of patients in the study group was lower than that of the control group at 7 days after operation,and the difference was statistically significant(P<0.05).There were no significant differences in D-D,TT,APTT,PT,AT-Ⅲlevels between the two groups at 3 days after operation(P>0.05).The D-D level of the research group was lower than that of the control group at 7 days after operation,and the difference was statistically significant(P<0.05).The level of AT-Ⅲin the study group was higher than that of the control group at 7 days after operation(P<0.05).There were no significant differences in TT,APTT and PT levels between the two groups at 7 days after operation(P>0.05).Conclusion Taking Rivaroxaban combined with rapid rehabilitation exercise can effectively reduce the postoperative D-D level and improve the blood flow speed,so as to effectively prevent the formation of DVT after total knee arthroplasty,and has little effect on the coagulation function,which is safe in clinical application and can be widely used in clinical practice.