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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 572 -577. doi: 10.3877/cma.j.issn.1674-134X.2020.05.009

所属专题： 文献；

临床论著

利伐沙班预防全膝关节置换术后深静脉血栓效果
柏正文1, 沈惠良1,†(), 安帅1   
  1. 1. 100053　北京，首都医科大学宣武医院
  • 收稿日期:2018-06-16 出版日期:2020-10-01
  • 通信作者: 沈惠良

Effect and complications of rivaroxaban in preventing deep venous thrombosis after total knee arthroplasty

Zhengwen Bai1, Huiliang Shen1,†(), Shuai An1   

  1. 1. Department of orthopedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2018-06-16 Published:2020-10-01
  • Corresponding author: Huiliang Shen
  • About author:
    Corresponding author: Shen Huiliang, Email:
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柏正文, 沈惠良, 安帅. 利伐沙班预防全膝关节置换术后深静脉血栓效果[J/OL]. 中华关节外科杂志(电子版), 2020, 14(05): 572-577.

Zhengwen Bai, Huiliang Shen, Shuai An. Effect and complications of rivaroxaban in preventing deep venous thrombosis after total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(05): 572-577.

目的

探讨为防止人工全膝关节置换术后深静脉血栓的形成及相关并发症应用利伐沙班的治疗价值。

方法

选取自2016年7月至2017年12月因膝关节骨关节炎于首都医科大学宣武医院骨科关节组行人工全膝关节置换术的患者，按照随机对照的原则抽取作为研究对象。排除有凝血功能障碍、血栓栓塞性病史或出血性病史，共84例患者，分为实验组和对照组各42例。实验组患者在术后给予利伐沙班抗凝治疗，对照组患者在术后给予依诺肝素抗凝治疗。比较两组患者术后深静脉血栓形成、肺栓塞及出血并发症(切口瘀斑、出血事件)的发生率，比较两组患者术后血液学指标的差异，比较两组患者引流量、输血量等相关指标。计量资料采用独立样本t检验；计数资料采取卡方检验。

结果

实验组患者术后早期深静脉血栓形成与对照组相比差异无统计学意义(χ2＝0.933，P>0.05)，两组患者均未发生肺栓塞；实验组早期出血并发症事件多于对照组(χ2＝6.574，P<0.05)。而两组患者术后血红蛋白、血小板、活化的部分凝血活酶时间、纤维蛋白原、D-二聚体相比差异均无统计学意义(P>0.05)；两组患者术后的引流量基本相同，两组的输血量、总失血量、隐性失血量相比均无统计学意义(P>0.05)。

结论

人工全膝关节置换术后应用利伐沙班作为抗凝药物，提供了抗凝治疗的便捷性，但其相关的出血并发症略高于依诺肝素，临床工作中可考虑分阶段使用以使得患者的受益最大化。

关键词: 利伐沙班, 依诺肝素, 关节成形术, 置换, 膝, 静脉血栓形成, 手术后并发症
Objective

To investigate the value of rivaroxaban in the treatment of deep venous thrombosis(DVT) and related complications after total knee arthroplasty.

Methods

Eighty-four patients of total knee arthroplasty due to knee osteoarthritis in Xuanwu Hospital from July 2016 to December 2017 were selected and randomly divided into experimental group (n =42) and the control group (n =42), the patients with coagulation dysfunction, thromboembolic history and bleeding history were excluded. The experimental group were given rivaroxaban anticoagulant therapy, while the control group were given enoxaparin anticoagulant therapy after the operation. The incidence of postoperative DVT, pulmonary embolism and bleeding complications (incision ecchymosis, bleeding events) were compared, and the differences of hematological indexes between the two groups were compared. The drainage volume, blood transfusion volume and other related indicators were compared between the two groups. The measurement data were analyzed by independent t test, chi-square test was used for count data.

Results

There was no statistically significant difference between the experimental group and the control group in early DVT incidence(χ2=0.933, P>0.05). No pulmonary embolism occured in the two groups, while the complications of early hemorrhage in the experimental group were higher than the control group (χ2=6.574, P<0.05). There was no statistically significant difference in hemoglobin, platelet, activated partial thromboplastin time, fibrinogen or D-dimer between the two groups (P>0.05). The drainage volume of the two groups was basically the same, and no statistically significant difference was found in the blood transfusion volume, total blood loss or hidden blood loss of the two groups (P>0.05).

Conclusion

Rivaroxaban as an anticoagulant after total knee arthroplasty provides the convenience of anticoagulant therapy, but its related bleeding complications are slightly higher than that of enoxaparin.

Key words: Rivaroxaban, Enoxaparin, Arthroplasty, replacement, knee, Venous thrombosis, Postoperative complications
表1 各组治疗前后各时间观察点WOMAC评分比较[分，(±s)]
一般项目 实验组 对照组 统计值 P值
例数 42 42    
年龄[岁，(±s)] 70±7 71±8 t＝0.260 >0.05
性别(例)        
男 4 7 χ2＝0.941 >0.05
女 38 35    
身高[cm，( ±s)] 158±7 159±7 t＝0.596 >0.05
体重[kg，( ±s)] 69±11 68±10 t＝0.414 >0.05
BMI[kg/m2，( ±s)] 27±3 27±4 t＝0.583 >0.05
手术侧别(例)        
左 17 20 χ2＝0.435 0.510
右 25 22    
手术史(例)        
有 13 10 χ2＝0.539 >0.05
无 29 32    
术前DVT(例)        
有 2 1 χ2＝0.346 >0.05
无 40 41    
表2 两组行TKA患者术后早期深静脉血栓形成、肺栓塞及出血并发症比较
组别 例数 术后早期DVT 术后早期PE 出血并发症
发生 未发生 发生 未发生 切口瘀斑 出血事件
实验组 42 14 28 0 42 10 2
对照组 42 10 32 0 42 2 1
χ2值   0.933 - 6.574
P值   >0.05 - <0.05
表3 两组患者术后血液学指标的比较(±s)
组别 例数 HB(g/L) PLT(109/L) APTT(s) FIB(mg/dl) D-D(ng/ml)
实验组 42 98.7±11.5 242.5±52.6 43.7±6.1 5.4±0.7 3.0±1.6
对照组 42 100.6±10.4 246.3±69.5 43.1±5.5 5.4±0.9 3.0±1.3
t值   0.973 0.298 0.422 0.249 0.022
P值   >0.05 >0.05 >0.05 >0.05 >0.05
表4 两组引流量、输血量、隐性失血等相关指标的比较(±s)
组别 引流量(ml) 输血量(ml) 总失血量(ml)
实验组 64±70 8±46 1 073±188
对照组 67±63 20±71 1 094±195
t值 0.260 0.927 0.500
P值 >0.05 >0.05 >0.05
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