两种抗凝药物预防老年患者腰椎融合术后深静脉血栓的效果分析

Efficacy analysis of two anticoagulant drugs for preventing deep vein thrombosis after lumbar fusion surgery in the elderly patients

目的探讨阿哌沙班与利伐沙班对老年患者腰椎融合术后深静脉血栓(DVT)的预防效果。方法将93例年龄≥65岁行腰椎融合术患者根据口服抗凝药物的不同分为两组:①A组48例,于术后12 h开始口服利伐沙班每天1次,每次10 mg,直至术后14 d;②B组45例,于术后12 h开始口服阿哌沙班每天2次,每次2.5 mg,直至术后14 d。记录手术情况、DVT发生情况、术后15 d双下肢髌上及髌下10 cm腿部的周长变化。结果手术时间、围手术期出血量、切口渗血率两组比较差异均无统计学意义(P>0.05)。两组均无神经根或硬膜损伤、感染、肺栓塞及出血等并发症发生;仅B组1例于右侧腘静脉发现DVT形成,无明显下肢肿胀、疼痛等症状,两组DVT发生例数比较差异无统计学意义(P>0.05)。术后15 d双下肢髌上及髌下10 cm腿部的周长变化两组比较差异均无统计学意义(P>0.05)。结论阿哌沙班与利伐沙班均使用方便,药效稳定,安全性高,既显著降低了老年患者腰椎融合术后DVT的发生率,又避免了相应的出血风险。

Objective To explore the efficacy of two different anticoagulant drugs for preventing deep vein thrombosis(DVT)after lumbar fusion surgery in the elderly patients.Methods The 93 patients(≥65 years old)who received lumbar fusion surgeries were divided into two groups,according to different oral anticoagulant drugs methods.①Group A of 48 patients were taken rivaroxaban 10 mg qd at 12 h after operation,until 14 d after operation;②Group B of 45 patients were taken apixaban 2.5 mg bid at 12 h after operation,until 14 d after operation.The operation situation,incidence of DVT,perimeter changes of legs at the superior and inferior 10 cm of the double lower limbs patella at 15 d were recorded.Results There were no statistically significant differences between the two groups in the surgery time,perioperative blood loss,and incision oozing rate of blood(P>0.05).No other serious complications such as injury of nerve root or dura mater,infection,pulmonary embolism,hemorrhage occurred in the two groups.Only 1 patient of group B developed DVT in right popliteal vein,who didn′t complain the symptoms such as swelling or pain in lower limb.Incidence cases number of DVT had no significantly statistical difference between the two groups(P>0.05).At 15 d after operation,there was no significant difference in perimeter changes of legs at the superior and inferior 10 cm of the double lower limbs(P>0.05).Conclusions Rivaroxaban and apixaban are easy use,stable efficacy and high safety,which not only significantly reduce the incidence rate of DVT after lumbar fusion surgery in elderly patients,but also avoid the corresponding bleeding risk.