利伐沙班与低分子肝素钙预防全髋关节置换术后深静脉血栓的效果比较-中国药房

利伐沙班与低分子肝素钙预防全髋关节置换术后深静脉血栓的效果比较

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篇名：	利伐沙班与低分子肝素钙预防全髋关节置换术后深静脉血栓的效果比较
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摘要：	目的：比较利伐沙班与低分子肝素钙预防全髋关节置换术（THA）后深静脉血栓（DVT）的临床效果及安全性。方法：收集我院骨科收治的100例行THA的患者作为研究对象，按照随机数字表法分为对照组和观察组，各50例。对照组患者皮下注射低分子肝素钙注射液0.4 mL，qd；观察组患者口服利伐沙班片10 mg，qd。两组患者均从术后第1天开始治疗，连续治疗10 d。观察两组患者治疗前后凝血指标[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、凝血酶时间（TT）、D-二聚体（D-D）]、视觉模拟评分法（VAS）评分及术后深静脉血栓（DVT）、肺栓塞（PE）发生率，比较两组患者术后出血量及血肿、胃肠道出血等不良反应发生情况。结果：治疗前，两组患者凝血指标及VAS评分比较，差异均无统计学意义（P＞0.05）。治疗后，两组患者PT、APTT、TT、D-D水平及VAS评分均显著降低，Fib水平显著升高，且观察组患者VAS评分显著低于对照组，差异均有统计学意义（P＜0.05）；两组患者凝血指标水平比较，差异无统计学意义（P＞0.05）。观察组患者DVT、PE发生率分别为8.00％、7.50％，与对照组的12.00％、4.00％比较，差异均无统计学意义（P＞0.05）。观察组患者术后出血量为（298.31±52.18）mL，显著低于对照组的（327.40±54.20）mL，差异有统计学意义（P＜0.05）。两组患者血肿及胃肠道出血的不良反应发生率比较，差异均无统计学意义（P＞0.05）。结论：利伐沙班与低分子肝素钙均能够明显改善患者凝血状态，预防THA后DVT的形成；利伐沙班还能缩短患者疼痛时间，且不会增加不良反应的发生风险。
ABSTRACT：	OBJECTIVE： To compare the clinical efficacy and safety of rivaroxaban and low molecular weight heparin calcium （LMWHA） in the prevention of deep venous thrombosis （DVT） after total hip arthroplasty （THA）. METHODS： A total of 100 THA patients selected from orthopedics department of our hospital as research objects were divided into control group and observation group according to random number table， with 50 cases in each group. Control group was treated with LMWHA injection 0.4 mL subcutaneously， qd； observation group was given Rivaroxaban tablet 10 mg orally， qd. Both groups received treatment on the first day after surgery， for consecutive 14 d. Coagulation indexes （PT， APTT， Fib， TT， D-D）， VAS score， the incidence of DVT and PE were observed in 2 groups. The postoperative bleeding volume and ADR as hematoma and gastrointestinal bleeding were compared between 2 groups. RESULTS： Before treatment， there was no statistical significance in coagulation indexes or VAS scores between 2 groups （P＞0.05）. After treatment， PT， APTT， TT and D-D levels， VAS scores of 2 groups were decreased significantly， while Fib levels were increased significantly； VAS score of observation group was significantly lower than that of control group， with statistical significance （P＜0.05）. There was no statistical significance in coagulation indexes between 2 groups （P＞0.05）. The incidence of DVT and PE in observation group were 8.00％ and 7.50％， which were significantly lower than 12.00％ and 4.00％ of control group， with no statistical significance （P＞0.05）. The postoperative bleeding volume of observation group was （298.31±52.18）mL， which was significantly lower than （327.40±54.20）mL of control group， with statistical significance （P＜0.05）. There was no statistical significance in the incidence of hematoma or gastrointestinal bleeding between 2 groups（P＞0.05）. CONCLUSIONS： Rivaroxaban and LMWHA can significantly improve coagulation state， prevent the generation of DVT after THA. While rivaroxaban is better in shortening pain time without increasing the risk of ADR.
期刊：	2017年第28卷第23期
作者：	邢贞武，余德涛，邢祯全，王　雷
AUTHORS：	XING Zhenwu，YU Detao，XING Zhenquan，WANG Lei
关键字：	利伐沙班；低分子肝素钙；全髋关节置换术；深静脉血栓；凝血功能
KEYWORDS：	Rivaroxaban； Low molecular weight heparin calcium； Total hip arthroplasty； Deep venous thrombosis； Coagulation function
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