利伐沙班联合尿激酶与AngioJet机械吸栓对骨科手术后深静脉血栓的治疗效果

Effect of oral rivaroxaban combined with urokinase and AngioJet mechanical thrombectomy on DVT after orthopedic surgery

目的探究口服利伐沙班联合尿激酶与AngioJet机械吸栓对骨科手术后深静脉血栓(DVT)的治疗效果。方法回顾性分析2021年1月至2023年4月丽水市中心医院骨科手术后发生DVT的112例患者的病历资料,根据治疗方法的不同分为对照组(49例)和观察组(63例),对照组接受尿激酶联合AngioJet机械吸栓治疗,观察组在对照组基础上联用利伐沙班,比较两组的临床疗效、患侧-健侧大小腿周径差、凝血功能指标及不良反应发生情况。结果观察组总有效率高于对照组(98.41%vs 87.76%,χ^(2)=0.028,P<0.05)。两组治疗前患侧-健侧大小腿周径及差值之间差异均无统计学意义(均P>0.05);治疗后,两组患侧-健侧小腿周径、患侧-健侧小腿周径均降低,且观察组患侧-健侧小腿周径、患侧-健侧小腿周径差值均高于对照组[(3.81±1.00)cm vs(3.13±0.96)cm、(2.46±0.51)cm vs(1.57±0.42)cm,t=3.633,9.882,均P<0.05]。两组治疗前活化部分凝血活酶时间(APTT),凝血酶时间(TT),凝血酶原时间(PT),纤维蛋白原(FIB)指标之间差异均无统计值意义(均P>0.05);治疗后,两组APTT、TT、PT均较治疗前缩短,FIB水平均较治疗下降,观察组APTT,TT,PT,FIB差值均高于对照组[(17.34±1.97)s vs(8.15±1.67)s、(8.09±1.04)s vs(3.92±1.36)s、(8.80±0.99)s vs(5.72±0.87)s、(2.88±0.88)g·L^(-1)vs(2.12±0.97)g·L^(-1),t=26.149,18.393,17.211,4.335,均P<0.05]。两组不良反应发生率差异无统计学意义(30.16%vs 28.57%,χ^(2)=0.033,P>0.05)。结论口服利伐沙班联合尿激酶与AngioJet机械吸栓能够提高骨科手术后DVT患者的疗效,改善患侧-健侧大小腿周径差和凝血功能,且具有一定的安全性。

Objective To investigate the effect of oral rivaroxaban combined with urokinase and AngioJet mechanical thrombectomy on deep vein thrombosis(DVT)after orthopedic surgery.Methods A total of 112 patients with DVT after orthopedic surgery treated in Lishui Central Hospital from January 2021 to April 2023 were retrospectively collected as the research subjects.According to the treatment methods,they were divided into the control group(n=49)and observation group(n=63).The patients in the control group received oral administration of urokinase combined with thrombus suction using AngioJet machine while those in the observation group were treated with rivaroxaban in addition to the regimen in the control group.The clinical efficacy,thigh circumference and calf circumference difference between the affected side and the unaffected side,coagulation indexes and occurrence of adverse reactions were analyzed and compared between the two groups.Results The effective rate of the observation group was higher than that of the control(98.41%vs 87.76%,χ^(2)=0.028,P<0.05).There was no significant difference in the thigh circumference and calf circumference between the affected side and the unaffected side in both groups before treatment(P>0.05).After treatment,the difference in the thigh circumference and calf circumference between the affected side and the unaffected side was reduced in both groups and it was significantly higher in the observation group than in the control((3.81±1.00)cm vs(3.13±0.96)cm,(2.46±0.51)cm vs(1.57±0.42)cm,t=3.633,9.882,both P<0.05).There was no significant difference in coagulation indexes between the two groups before treatment(P>0.05).After treatment,APTT,TT and PT were shortened in both groups,and FIB expression levels were decreased.In terms of difference,the observation group was higher than the control((17.34±1.97)s vs(8.15±1.67)s,(8.09±1.04)s vs(3.92±1.36)s,(8.80±0.99)s vs(5.72±0.87)s,(2.88±0.88)g·L^(-1) vs(2.12±0.97)g·L^(-1),t=26.149,18.393,17.211,4.335,all P<0.05).No significant difference was found in the incidence of adverse reactions between the two groups(30.16%vs 28.57%,χ^(2)=0.033,P>0.05).Conclusion Urokinase combined with AngioJet mechanical thrombectomy and oral administration of rivaroxaban can promote the efficacy in treatment of DVT after orthopedic surgery,decrease difference in thigh circumference and calf circumference between the affected side and the unaffected side and improve the coagulation condition.Furthermore,it has a certain degree of safety.