摘要
目的比较短期和延长抗凝在髋关节置换手术患者中对预防下肢深静脉血栓(DVT)的作用效果。方法选取2012年8月至2014年1月在上海交通大学医学院附属瑞金医院卢湾分院行人工髋关节置换术的64例患者为研究对象,按照随机数字表法将患者分为短期抗凝组和延长抗凝组,各32例。在物理预防措施的基础上,短期抗凝组患者术后口服利伐沙班7 d(10 mg/d),延长抗凝组术后口服利伐沙班35 d(10 mg/d)。两组在术前、术后均进行下肢彩色多普勒超声检查,检测两组患者术前、术后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段F1+2(F1+2)以及D-二聚体水平并进行比较。结果短期抗凝组在术后第7日发现2例(6.2%)DVT,延长抗凝组在治疗期间未发现DVT,两组DVT发生率比较,差异无统计学意义(P>0.05)。两组PT、APTT的组间、不同时点间、组间·不同时点间交互作用比较差异无统计学意义(P>0.05);两组患者术后第7日、14日的FIB均显著高于术前(P<0.05),术后第1、7、14、21、35日的D-二聚体均显著高于术前(P<0.05);两组患者术后第1、7、14、21、35日的TAT、F1+2均显著高于术前(P<0.05),且延长抗凝组的TAT、F1+2均显著低于短期抗凝组(P<0.05)。安全性方面,两组患者在治疗期间均未发现严重出血,两组术后引流量和皮下瘀斑面积比较,差异无统计学意义(P>0.05)。结论短期和延长抗凝在预防DVT的发生率和安全性方面均无显著差异,延长抗凝时限可以在一定程度上减轻术后高凝状态的程度,但不能完全消除高凝状态。
Objective To compare the effects of short-term and prolonged thromboprophylaxis in patients with total hip replacement. Methods Total of 64 patients with total hip replacement who received total hip replacement in Luwan Branch of Ruijin Hospital Shanghai Jiaotong University School of Medicine from Aug. 2012 to Jan. 2014 were enrolled in the study and randomly divided into short-term thromboprophylaxis group（ n = 32） and prolonged thromboprophylaxis group（ n = 32） according to the random number table. Based on physical prevention measures,patients in the short-term thromboprophylaxis group took rivaroxaban（ 10 mg / d） for 7 days,while patients in the prolonged thromboprophylaxis group took rivaroxaban（ 10 mg/d） for 35 days. Two groups were examined by color Doppler ultrasonic before and after surgery. Prothrombin time（ PT）,activated partial thromboplastintime（ APTT）,fibrinogen（ FIB）,thrombin-antithrombin complexes（ TAT）,prothrombin fragment 1 ＋ 2（ F1 ＋ 2）,and D-dimer of the two groups were examined before and after surgery. Results Short-term thromboprophylaxis group had 2（ 6. 2%） deep vein thrombosis（ DVT） at day 7 post-operation,while prolonged thromboprophylaxis group had no DVT. The differences of incidence of DVT of the two groups were not statistically significant（ P〈0. 05）. For PT and APTT,there were no significant difference between the two groups and among all time points（ P〉0. 05）. FIB of the two groups of patients after 7 days,14 days were significantly higher than that before operation（ P〈0. 05）,postoperative 1,7,14,21 and 35 days D-dimer were significantly higher than before operation（ P〈0. 05）; after1,7,14,21 and 35 days Tat and F1 ＋ 2 of the two groups were significantly higher than before operation（ P〈0. 05） and Tat and F1 ＋ 2 of the prolonged thromboprophylaxis group were significantly lower than the short-term thromboprophylaxis group（ P〈0. 05）. Severe bleeding were not found in both groups during the treatment. The differences of postoperative drainage and subcutaneous ecchymosis area of the two groups were not statistically significant（ P〉0. 05）. Conclusion The incidence of DVT and safety of short-term and prolonged thromboprophylaxis have no significant difference. Although not completely eliminated,the status of hypercoagulability after total hip replacement could be reduced by prolonged thromboprophylaxis.
出处
《医学综述》
2015年第24期4575-4577,共3页
Medical Recapitulate
关键词
深静脉血栓
髋关节置换术
抗凝
Deep vein thrombosis
Hip replacement
Thromboprophylaxis
