摘要
目的分析比较低分子肝素与利伐沙班在预防脊柱外科术后下肢深静脉血栓的疗效和安全性。方法选择2016年1月至2019年1月于汉川市人民医院180例行脊柱手术的病人按随机数字表法分为对照组和观察组,各组90例。两组病人均于术后第1天至2个月采用物理预防。观察组病人术后给予利伐沙班(10毫克/片)每晚1次1片口服;对照组病人术后给予低分子肝素钙注射液(0.4 mL∶4100 U抗Ⅹa因子/支)每天1次1支皮下注射;两组均治疗14 d。比较两组病人术前、术后7 d及术后14 d的凝血酶原时间(PT)、纤维蛋白原(FIB)及D⁃二聚体(D⁃D)等凝血指标和下肢深静脉血栓发生率及不良反应的发生情况。结果对照组发生3例血栓栓塞,其中2例为症状性血栓栓塞(2.22%),1例为无症状性血栓栓塞(1.11%);观察组发生1例无症状性血栓栓塞(1.11%);两组发生血栓栓塞总例数比较,差异无统计学意义(P>0.05)。治疗前,两组病人的术前PT、FIB、D⁃D水平比较,差异无统计学意义(P>0.05)。术后7 d,两组病人PT水平比较,差异无统计学意义(P>0.05);术后14 d,两组病人PT水平均显著高于同组术前(P<0.05),观察组PT显著高于对照组(P<0.05)。术后7 d及14 d时,两组病人FIB、D⁃D水平较术前均显著升高(P<0.05);观察组FIB、D⁃D水平显著低于对照组(P<0.05)。两组病人不良反应表现为:牙龈出血、皮下瘀斑、粪便隐血、肝功能损害及活化部分凝血酶时间异常,其中对照组共9例不良反应(10.00%),观察组共发生8例不良反应(8.89%),两组各类不良反应发生率及两组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论低分子肝素与利伐沙班在预防脊柱外科手术后下肢深静脉血栓方面疗效确切,安全性好,并且伐沙班在改善凝血功能方面优于低分子肝素。
Objective To compare the efficacy and safety of LMWH and rivaroxaban in the prevention of deep venous thrombosis of lower limbs after spinal surgery.Methods One hundred and eighty patients who underwent spine surgery in Hanchuan People’s Hospital from January 2016 to January 2019 were randomly assigned into control group and observation group,90 cases in each group.Physical prophylaxis was used from the 1st day to 2 months after surgery in both groups.On this basis,patients in the observa⁃tion group began to take rivaroxaban tablets(10 mg/tablet)orally once a night after the operation;patients in the control group were given low⁃molecular⁃weight heparin calcium injection(0.4 mL:4100 U anti⁃factor Xa/bottle)daily after the operation 1 subcutane⁃ous injection once.Both groups of patients were maintained treatment for 14 days,the clotting indexes including prothrombin time(PT),fibrinogen(FIB)and d⁃dimer(D⁃D)before,7 days and 14 days after surgery,as well as the incidence and adverse reactions of deep vein thrombosis in lower limbs were compared between the two groups.Results Postoperative thromboembolism occurred in 3 patients in the control group after spinal surgery,including 2 patients with symptomatic thromboembolism(2.22%)and 1 pa⁃tient with asymptomatic thromboembolism(1.11%).One case of asymptomatic thromboembolism(1.11%)occurred in the observa⁃tion group.There was no statistically significant difference in the total number of patients with thromboembolism between the two groups(P>0.05).Before treatment,there were no significant differences in preoperative PT,FIB,and D⁃D levels between the two groups(P>0.05).7 days after surgery,there was no significant difference in PT levels between the two groups(P>0.05),while 14 days after surgery,the PT levels in both groups were significantly higher than preoperative PT levels(P<0.05),and the PT lev⁃el in the observation group was significantly higher than that in the control group(P<0.05).At 7 days and 14 days after surgery,the levels of FIB and
作者
宋江涛
陈嘉联
SONG Jiangtao;CHEN Jialian(Department of Orthopedics,Hanchuan People’s Hospital(Hanchuan Hospital,People’s Hospital of Wuhan University),Hanchuan,Hubei 431600,China)
出处
《安徽医药》
CAS
2020年第12期2519-2522,共4页
Anhui Medical and Pharmaceutical Journal
关键词
静脉血栓形成
矫形外科手术
脊柱
下肢
肝素
低分子量
利伐沙班
Venous thrombosis
Orthopedic procedures
Spine
Lower extremity
Heparin,low⁃molecular⁃weight
Rivaroxaban
