依诺肝素钠与磺达肝癸钠预防膝关节置换术后深静脉血栓的对比研究

Comparative Study on Enoxaparin Sodium and Fondaparinux Sodium in the Prevention of Deep Venous Thrombosis after Knee Arthroplasty

目的:对比依诺肝素钠与磺达肝癸钠预防膝关节置换术后深静脉血栓(deep venous thrombosis,DVT)的有效性和安全性。方法:选取2017年4月至2020年4月于攀枝花学院附属医院骨科医院首次行膝关节置换术的患者178例作为研究对象,采用随机数字表法分为依诺肝素钠组和磺达肝癸钠组,每组89例。依诺肝素钠组患者使用依诺肝素钠注射液,磺达肝癸钠组患者使用磺达肝癸钠注射液,两组患者均连续治疗14 d。观察两组患者的临床疗效、DVT发生情况和皮下瘀斑发生情况,治疗前后两组患者的凝血功能指标水平、下肢静脉血流速度,以及住院时间、不良反应发生情况。结果:依诺肝素钠组患者的DVT发生率为3.37%(3/89),明显低于磺达肝癸钠组的11.24%(10/89);依诺肝素钠组患者的皮下瘀斑发生率为2.25%(2/89),明显低于磺达肝癸钠组的13.48%(12/89),组间比较,差异均有统计学意义(P<0.05)。治疗前和治疗后,两组患者D-二聚体、纤维蛋白原、血小板计数和活化部分凝血活酶时间,左、右侧股静脉和腘静脉的血流速度,膝关节活动度评分和美国膝关节协会评分(American knee society score,KSS),组间比较,差异均无统计学意义(P>0.05)。依诺肝素钠组患者的不良反应发生率明显低于磺达肝癸钠组;随访1年时,依诺肝素钠组患者的膝关节活动度评分、KSS评分明显高于磺达肝癸钠组,差异均有统计学意义(P<0.05)。结论:在预防膝关节置换术后DVT中,依诺肝素钠的有效性和安全性均优于磺达肝癸钠。

OBJECTIVE:To compare the efficacy and safety between enoxaparin sodium and fondaparinux sodium in the prevention of deep venous thrombosis(DVT)after knee arthroplasty.METHODS:Totally 178 patients undergoing knee arthroplasty for the first time admitted into Orthopedics Hospital of Affiliated Hospital of Panzhihua University from Apr.2017 to Apr.2020 were selected and divided into enoxaparin sodium group and fondaparinux sodium group via random number table,with 89 cases in each group.The enoxaparin sodium group was given enoxaparin sodium injection,while the fondaparinux sodium group was given fondaparinux sodium injection,both groups were treated for continuous 14 days.The clinical efficacy,incidences of DVT and subcutaneous ecchymosis,coagulation function indicators and velocity of basal vein rate of lower limbs before and after treatment,length of stay and incidences of adverse drug reactions were observed in both groups.RESULTS:The incidence of DVT of enoxaparin sodium group was 3.37%(3/89),which was significantly lower than that of the fondaparinux sodium group(11.24%,10/89);the incidence of subcutaneous ecchymosis of enoxaparin sodium group was 2.25%(2/89),which was significantly lower than that of the fondaparinux sodium group(13.48%,12/89),the differences between two groups were statistically significant(P<0.05).There were no statistically significant differences in D-dimer,fibrinogen,platelet count and activated partial thromboplastin time,blood flow velocity in left and right femoral and popliteal veins,knee mobility score and American knee society score(KSS)between two groups before and after treatment(P>0.05).The incidence of adverse drug reactions of enoxaparin sodium group was significantly lower than that of the fondaparinux sodium group;at 1-year follow-up visit,the knee mobility score and KSS of enoxaparin sodium group were significantly higher than those of the fondaparinux sodium group,with statistically significant differences(P<0.05).CONCLUSIONS:Enoxaparin sodium has better effectiveness and safety than fondaparinux sodium in preventing deep vein thrombosis in patients after knee arthroplasty.