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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: 骨科学 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. 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. 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:
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/OL]. 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/OL]. 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。

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 3rd 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 3rd 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.

表1 两组患者手术前及术后第3天Hb、HCT比较(±s)
表2 两组患者手术前及术后第3天凝血指标比较(±s)
表3 术后出血情况及Harris评分比较
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