利伐沙班联合局部使用氨甲环酸在初次全髋置换术中应用效果

doi:10.3877/cma.j.issn.1674-134X.2018.03.001

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 300 -304. doi: 10.3877/cma.j.issn.1674-134X.2018.03.001

所属专题：文献；

临床论著

利伐沙班联合局部使用氨甲环酸在初次全髋置换术中应用效果

吴兴净¹, 王坤正²^,^†(

), 樊立宏², 汪正宇¹, 陶周善¹, 谢加兵¹, 丁国正¹, 徐祝军¹

^1. 241001　芜湖，皖南医学院弋矶山医院骨科
^2. 710004　西安交通大学第二附属医院骨科

收稿日期:2017-04-04 出版日期:2018-06-01
通信作者: 王坤正
基金资助:
皖南医学院弋矶山医院博士引进人才基金(编号：YR201513)

Clinical efficacy of rivaroxaban combined with topical application of tranexamic acid in primary total hip arthroplasty

Xingjing Wu¹, Kunzheng Wang²^,^†(), Lihong Fan², Zhengyu Wang¹, Zhoushan Tao¹, Jiabing Xie¹, Guozheng Ding¹, Zhujun Xu¹

^1. Department of Orthopedics, Yijishan Hospital of wannan medical college, Wuhu 241001, China
^2. Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China

Received:2017-04-04 Published:2018-06-01
Corresponding author: Kunzheng Wang
About author:
Corresponding author: Wang Kunzheng, Email: drkunzhengwang@126.com

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引用本文：

吴兴净, 王坤正, 樊立宏, 汪正宇, 陶周善, 谢加兵, 丁国正, 徐祝军. 利伐沙班联合局部使用氨甲环酸在初次全髋置换术中应用效果[J]. 中华关节外科杂志(电子版), 2018, 12(03): 300-304.

Xingjing Wu, Kunzheng Wang, Lihong Fan, Zhengyu Wang, Zhoushan Tao, Jiabing Xie, Guozheng Ding, Zhujun Xu. Clinical efficacy of rivaroxaban combined with topical application of tranexamic acid in primary total hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 300-304.

目的

探讨利伐沙班联合局部注射氨甲环酸在初次单侧全髋置换术(THA)中应用效果。

方法

纳入标准：年龄≥60岁、初次单侧THA、无利伐沙班和氨甲环酸过敏史。排除标准：发生过深静脉血栓、肺栓塞或术前血管彩超异常；血常规异常及凝血功能紊乱；心脑血管意外史；严重心肺肝肾功能不全。2012年1月至2014年1月于西安交通大学第二附属医院骨科行初次单侧THA的符合入选条件的患者146例，分为利伐沙班联合氨甲环酸组(实验组73例)和利伐沙班组(对照组73例)，对以下计量指标进行t检验：年龄、体重指数、手术时间、总失血量、术中失血量、术后引流量、术前及术后第3天血红蛋白、红细胞比容和凝血指标、术后6个月Harris评分。对以下计数指标进行卡方检验：性别构成、疾病类型、输血例数。

结果

两组患者的年龄(t＝0.657，P> 0.05)、性别(χ²＝0.068，P>0.05)、体重指数(t＝1.026，P>0.05)、疾病类型(χ²＝0.383，P>0.05)及手术时间(t＝0.193，P>0.05)之间的差异均没有统计学意义，表明两组患者具有可比性。实验组与对照组在失血总量(t＝16.876，P<0.05)、术后引流量(t＝15.203，P<0.05)、输血例数(χ²＝6.032，P<0.05)、术后第3天血红蛋白值(t＝4.874，P<0.05)、红细胞比容(t＝5.768，P<0.05)方面的差异有统计学意义；实验组失血总量、术后引流量、输血例数均明显少于对照组；实验组术后第3天血红蛋白值、红细胞比容均明高于对照组，差异有统计学意义。两组患者术后均无血栓事件发生。

结论

局部使用氨甲环酸联合利伐沙班在老年初次单侧THA术中不仅不影响患者全身的凝血系统，能有效预防下肢深静脉栓塞，而且还可以明显减少出血。

关键词: 关节成形术，置换，髋, 利伐沙班, 氨甲环酸, 静脉血栓, 失血，手术

Objective

To explore the effect of rivaroxaban combined with local use of tranexamic acid in primary total hip arthroplasty(THA).

Methods

Inclusion criteria: age≥60 years, primary THA, no rivaroxaban and ammoniacal acid allergy. Exclusion criteria: deep venous thrombosis, pulmonary embolism or abnormal preoperative blood vessels, abnormal blood routine and blood coagulation dysfunction, cardiovascular and cerebrovascular diseases, severe cardiopulmonary renal insufficiency. A total of 146 patients undergoing primary total hip arthroplasty in the orthopedic department of the Second Affiliated Hospital of Xi’an Jiaotong University from January 2012 to January 2014 were selected and divided into the rivaroxaban + tranexamic acid group (the treatment group, n=73) and the rivaroxaban group(the control group, n=73). The following continuous variables were analyzed by t test: age, body mass index(BMI), operation time, total and intraoperative blood loss, drainage volume, preoperative hemoglobin(Hb), hematocrit(HCT) and coagulation index, as well as postoperative Hb, HCT, coagulation index on the 3^rd day and Harris hip function score in the 6th month. The following discrete variables were analyzed by Chi-square test: gender, disease types, transfusion cases.

Results

There was no significant difference in age(t=0.657, P>0.05), gender(χ²=0.068, P>0.05), BMI(t=1.026, P>0.05), disease types(χ²=0.383, P>0.05) or operation time(t=0.193, P>0.05)between the two groups. The total blood loss(t=16.876, P<0.05), drainage volume(t=15.203, P<0.05), transfusion cases(χ²=6.032, P<0.05) in the experimental group were significantly less than those in the control group, the differences were statistically significant ; the postoperative Hb (t=4.874, P<0.05)and HCT(t=5.768, P<0.05)of the experimental group were significantly higher than those of the control group on the 3^rd day. The postoperative hrombosis events didn’t occur in the two groups.

Conclusion

Combined application of tranexamic acid and rivaroxaban in the primary THA of elderly patients does not affect the blood coagulation system, which can reduce the risk of postoperative thrombosis and the blood loss.

Key words: Arthroplasty, replacement, hip, Rivaroxaban, Tranexamic acid, Venous thrombosis, Blood loss, surgical

表1 两组患者手术前及术后第3天Hb、HCT比较(±s)

组别	例数	术前Hb(g/L)	术后3 d Hb(g/L)	术前HCT(%)	术后3 d HCT(%)
实验组	73	135.4±8.9	89.3±6.4	39.4±3.8	32. 4±2.3
对照组	73	136.4±7.5	81.8±10.7	40.7±3.3	27. 1± 2.4
t值	?	0.287	4.874	0.386	5.768
P值	?	>0.05	<0.05	>0.05	<0.05

表1 两组患者手术前及术后第3天Hb、HCT比较(±s)

组别	例数	术前Hb(g/L)	术后3 d Hb(g/L)	术前HCT(%)	术后3 d HCT(%)
实验组	73	135.4±8.9	89.3±6.4	39.4±3.8	32. 4±2.3
对照组	73	136.4±7.5	81.8±10.7	40.7±3.3	27. 1± 2.4
t值	?	0.287	4.874	0.386	5.768
P值	?	>0.05	<0.05	>0.05	<0.05

表2 两组患者手术前及术后第3天凝血指标比较(±s)

组别	例数	纤维蛋白原(g/L)		凝血酶原时间(s)		D－二聚体(s)
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d
实验组	73	3.95±0.73	3.73±0.57	11.47±0.58	12.04±0.28	0.35 ±0.02	0.37±0.04
对照组	73	3.87±0.64	3.64±0.92	10.55±2.47	11.35±3.41	0.34 ±0.06	0.36±0.07
t值	?	0.876	1.037	1.082	0.985	0.201	0.413
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组患者手术前及术后第3天凝血指标比较(±s)

组别	例数	纤维蛋白原(g/L)		凝血酶原时间(s)		D－二聚体(s)
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d
实验组	73	3.95±0.73	3.73±0.57	11.47±0.58	12.04±0.28	0.35 ±0.02	0.37±0.04
对照组	73	3.87±0.64	3.64±0.92	10.55±2.47	11.35±3.41	0.34 ±0.06	0.36±0.07
t值	?	0.876	1.037	1.082	0.985	0.201	0.413
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表3 术后出血情况及Harris评分比较

组别	例数	总失血量[ml, (±s)]	术中出血量[ml，(±s)]	引流量[ml，(±s)]	输血例数[例，(%)]	Harris评分(±s)
实验组	73	767±37	465±65	384±90	12(16)	81±4
对照组	73	1217±49	470±49	780±77	30(41)	80±8
统计值	?	t＝16.876	t＝0.317	t＝15.203	χ²＝6.032	t＝1.635
P值	?	<0.05	>0.05	<0.05	<0.05	>0.05

表3 术后出血情况及Harris评分比较

组别	例数	总失血量[ml, (±s)]	术中出血量[ml，(±s)]	引流量[ml，(±s)]	输血例数[例，(%)]	Harris评分(±s)
实验组	73	767±37	465±65	384±90	12(16)	81±4
对照组	73	1217±49	470±49	780±77	30(41)	80±8
统计值	?	t＝16.876	t＝0.317	t＝15.203	χ²＝6.032	t＝1.635
P值	?	<0.05	>0.05	<0.05	<0.05	>0.05

[1]	Lovald ST, Ong KL, Lau EC, et al. Mortality, cost, and downstream disease of total hip arthroplasty patients in the Medicare population[J]. J Arthroplasty, 2014, 29(1):242-246.
[2]	钱东阳，白波，严广斌，等．髋膝关节置换围手术期下肢深静脉血栓形成与D－二聚体及抗凝药的关系[J/CD]．中华关节外科杂志(电子版)，2014，8(2):181-184.
[3]	王波. 微量低分子肝素对髋关节置换术血液流变学的影响[D]. 泸州：泸州医学院，2014
[4]	李建昌，穆臣会，郭氧．利伐沙班预防髋关节置换术后深静脉血栓的效果观察[J]．中国生化药物杂志，2015，35(12):148-149.
[5]	Lee YC, Park SJ, Kim JS, et al. Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement[J]. J Clin Anesth, 2013, 25(5):393-398.
[6]	Borghi B, Borghi R. Blood-Saving techniques[J]. Transplant Proc, 2011, 43(1):333-337.
[7]	Irisson E, Hemon Y, Pauly V, et al. Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery[J]. Orthop Traumatol Surg Res, 2012, 98(5):477-483.
[8]	Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement[J]. Br J Anaesth, 2003, 90(5):596-599.
[9]	Fuji T, Fujita S, Kawai Y, et al. Efficacy and safety of edoxaban versus enoxaparin for the prevention of venous thromboembolism following total hip arthroplasty: STARS J-V[J]. Thromb J, 2015, 13(1):27.
[10]	Huang F, Wu D, Ma G, et al. The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis[J]. J Surg Res, 2014, 186(1):318-327.
[11]	Jauregui JJ, Issa K, Kapadia BH, et al. Post-operative blood management strategies for total hip arthroplasty[J]. Surg Technol Int, 2014, 24(3):333-337.
[12]	Blanié A, Bellamy L, Rhayem Y, et al. Duration of postoperative fibrinolysis after total hip or knee replacement: a laboratory follow-up study[J]. Thromb Res, 2013, 131(1):e6-e11.
[13]	Aguilera-Roig X, Jordan-Sales M, Natera-Cisneros L, et al. [Tranexamic acid in orthopedic surgery] [J]. Rev Esp Cir Ortop Traumatol, 2014, 58(1):52-56.
[14]	殷晗，王大伟，马文谱，等．经引流管逆行注入氨甲环酸降低初次全髋置换术后失血量的有效性及近期安全性评估[J/CD]．中华关节外科杂志(电子版)，2014，8(05):669-672.
[15]	胡栢均，高大伟，林志炯．氨甲环酸和低分子肝素在髋关节置换围手术期的应用[J]．青岛医药卫生，2015，47(6):435-436.
[16]	Mahaffey R, Wang L, Hamilton A, et al. A retrospective analysis of blood loss with combined topical and intravenous tranexamic acid after coronary artery bypass graft surgery[J]. J Cardiothorac Vasc Anesth, 2013, 27(1):18-22.
[17]	Raveendran R, Wong J. Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain[J]. Evid Based Med, 2013, 18(2):65-66.
[18]	Harenberg J, Du S, Wehling M, et al. Measurement of dabigatran, rivaroxaban and apixaban in samples of plasma, serum and urine, under real Life conditions. An international study[J]. Clin Chem Lab Med, 2016, 54(2):275-283.

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