利伐沙班联合间歇充气加压使用时机对老年髋部骨折术后下肢深静脉血栓效果

Effect of rivaroxaban combined with intermittent pneumatic compression at different times on the prevention of lower extremity deep venous thrombosis after hip orthopedics in the elderly

目的比较利伐沙班联合间歇充气加压(intermittent pneumatic compression,IPC)使用时机预防老年髋部手术患者下肢深静脉血栓(deep vein thrombosis,DVT)的效果。方法前瞻性选取2019年10月~2021年9月四川省骨科医院老年骨科收治的单侧股骨颈骨折/行髋关节置换术的老年患者108例,按照随机数表法分为利伐沙班联合术前IPC组(54例)、利伐沙班联合术后IPC组(53例,54例中1例失访)。比较术后第2周、第5周DVT发生率。比较术中出血量和术后伤口引流量。比较术前及术后2周D-二聚体(D-D)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),观察两组凝血功能的差异。比较术后黑便、血尿、咯血等出血征象及其他不良反应。结果术前两组D-D、PT和APTT水平差异无统计学意义(P>0.05),术后2周利伐沙班联合术前IPC组D-D水平低于联合术后组,组间差异有统计学意义(P<0.05)。两组术后2周PT、APTT时间差异无统计学意义(P>0.05)。两组术中出血量及术后引流量比较,差异无统计学意义(P>0.05)。术后2周利伐沙班联合术前IPC组DVT发生率5.55%(3/54)低于利伐沙班联合术后IPC组发生率15.09%(8/53),两组比较,差异有统计学意义(P<0.05)。在术后5周检查时,包括之前发现的DVT患者在内,利伐沙班联合术前IPC组DVT发生率11.11%(6/54),低于利伐沙班联合术后IPC组的16.98%(9/53),但组间差异无统计学意义(P>0.05)。结论对于老年髋部骨科手术患者,采用利伐沙班联合术前应用间歇充气加压装置降低术后DVT发生率效果优于术后联合IPC,且不增加出血风险,安全性较好。

Objective To compare the effects of intermittent pneumatic compression at different times combined with rivaroxaban on the prevention of DVT in elderly patients undergoing hip surgery.Methods Elderly patients with femoral neck fracture/hip replacement were divided into rivaroxaban combined with preoperative IPC group(54 cases)and rivaroxaban combined with postoperative IPC group(53 cases).The incidence of DVT at 2 and 5 weeks after operation was compared.The amount of intraoperative bleeding and postoperative wound drainage were compared.D-Dimer(D-D),plasma prothrombin time(PT)and APTT were compared before and 2 weeks after operation.The bleeding signs such as black stool,hematuria,hemoptysis and other adverse reactions were compared.Results There was no significant difference in the levels of D-D,PT and APTT between the two groups before operation(P>0.05).2 weeks after operation,the level of D-D in rivaroxaban combined with IPC group was lower than that in combined group,and there was significant difference between the two groups(P<0.05).There was no significant difference in PT and APTT time between the two groups 2 weeks after operation(P>0.05).There was no significant difference in intraoperative bleeding and postoperative drainage between the two groups(P>0.05).Two weeks after operation,the incidence of DVT in rivaroxaban combined with preoperative IPC group was 5.55%(3/54)lower than that in rivaroxaban combined with postoperative IPC group was 15.09%(8/53).There was significant difference between the two groups(P<0.05).At 5 weeks after operation,the incidence of DVT in rivaroxaban combined with preoperative IPC group was 11.11%(6/54),lower than 16.98%(9/53)in rivaroxaban combined with postoperative IPC group,but there was no significant difference between the groups(P>0.05).Conclusion For elderly patients undergoing hip orthopedic surgery,rivaroxaban combined with preoperative intermittent inflatable compression device can reduce the incidence of postoperative DVT without increasing the risk of bleeding,it’s better than that of postoperative combined IPC.