摘要
目的 探究利伐沙班对股骨颈骨折的老年糖尿病患者髋关节置换术后预防深静脉血栓(DVT)形成的影响。方法 将我院于2018年9月—2021年6月收治的236例股骨颈骨折老年糖尿病患者根据是否加用利伐沙班将患者分为观察组(加用利伐沙班)和对照组(不加用利伐沙班),每组118例患者。比较两组患者经髋关节置换术后反应时间(R时间)、凝块形成时间(K时间)、α角度、最大强度(MA)、凝块弹性(G)、凝血指数(CI)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)等指标。DVT由彩色多普勒超声诊断。通过Logistic回归分析DVT的危险因素。结果 入院当天两组患者R时间、K时间、α角等TEG参数间比较差异无统计学意义(P>0.05);术前,与对照组相比,观察组R时间延长,α角、MA和G降低(P<0.05),K时间和CI比较差异无统计学意义(P>0.05);与术前相比,观察组术后R时间、K时间延长,α角、MA、G、CI降低(P<0.05)。术前两组血小板、血红蛋白数量及PT、APPT比较差异无统计学意义(P>0.05);术后,观察组血小板、血红蛋白含量、PT和APPT低于对照组(P<0.05)。与术前相比,观察组术后PT、APPT、血小板和血红蛋白含量无明显变化(P>0.05),而对照组术后PT和APPT延长,血小板和血红蛋白数手术后显著增加(P<0.05)。DVT发病率高于观察组(18.6%vs 5.1%,P<0.05)。BMI>25、异常凝血指标、术后使用骨水泥型股骨假体、高血红蛋白含量和非踝关节泵运动均为DVT的危险因素。两组患者轻微出血、血肿、皮下瘀斑发生率比较差异无统计学意义(P>0.05),对照组患者切口出血时间长于观察组(P<0.05)。结论 利伐沙班可有效预防老年糖尿病患者股骨颈骨折髋关节置换术后的DVT形成,提高患者临床治疗效果。
Objective To explore the effect of rivaroxaban on the prevention of deep vein thrombosis(DVT)in elderly diabetic patients with femoral neck fracture after hip replacement.Methods 236 elderly diabetic patients with femoral neck fracture were randomly divided into rivaroxaban observation group and control group.Compare the reaction time(R time),clot formation time(K time),αangle,maximum intensity(MA),clot elasticity(G),coagulation index(CI),the original time(PT)and activated partial thromboplastin time(APTT)and other indicators.DVT is diagnosed by color Doppler ultrasound.Logistic regression was used to analyze the risk factors of DVT.Results Compared with the control group,the R time and K time of the rivaroxaban observation group were prolonged,a angle MA and G decreased one day before the operation.One day after the operation,PT and APTT of the rivaroxaban observation group decreased,and the incidence of DVT was lower than that of the control group.There were significant differences in PT and APTT between the two groups before and after operation.Body mass index(BMI)>25,abnormal coagulation indexes,postoperative use of cemented femoral prosthesis,high hemoglobin content,and non-ankle pump exercise are risk factors for DVT.Conclusion After hip replacement,rivaroxaban can effectively prevent the formation of DVT of femoral neck fracture in elderly diabetic patients and improve the clinical treatment effect of patients.
作者
罗德军
张兆尧
何发友
朱庆茂
杨博
LUO Dejun;ZHANG Zhaoyao;HE Fayou;ZHU Qingmao;YANG Bo(The People's Hospital of Jianyang,Jianyang 641400,Sichuan,China)
出处
《西部医学》
2023年第8期1208-1212,共5页
Medical Journal of West China
基金
四川省医学会课题(S17036)。
