利伐沙班联合间歇充气加压装置对人工髋关节置换术后下肢深静脉血栓预防的研究

发布时间：2018-06-24 21:17

本文选题：利伐沙班 + 间歇充气加压装置　；参考：《新乡医学院》2014年硕士论文

【摘要】：背景由于下肢深静脉血栓是人工关节置换术后最常见并发症之一,相关研究表明,如果没有有效的预防措施,髋关节术后患者深静脉血栓发生率可以高达为45%～75%,肺血栓栓塞症发生率约为0.1%～2.0%,深静脉血栓引起对机体的损伤非常严重,抗凝药物与机械性预防的联合使用为国内外专家推荐,但相关文献报道不多。因此,探讨不同时期联合使用抗凝药物与间歇充气加压装置对预防关节置换术后下肢深静脉血栓形成有着重要意义。目的通过运用人工髋关节置换术后联合应用利伐沙班及间歇充气加压装置(IPC)不同使用方式,比较预防人工关节置换术后下肢深静脉血栓(DVT)的效果和围手术期出血量,研究探讨预防人工关节置换术后下肢深静脉血栓形成有效而又安全的新方法。方法 2013年9月至2014年3月,150例人工髋关节置换手术病例,随机分成3组。A组50例,术前12小时即开始口服利伐沙班(10g/天),麻醉开始时即开始使用IPC;B组50例,术后10小时口服利伐沙班(10g/天),麻醉开始时即使用IPC;C组50例,术后10小时后即开始口服利伐沙班(10g/天),术毕后使用IPC。三组患者分别在性别、身高、年龄、体重及病程等一般资料的比较上,均无统计学意义(p0.05)。三组患者在手术前准备以及术后用药上基本一致,为了尽可能保证手术操作的一致性,所有由本院同一组医生进行手术操作,术后常规观察患者有无下肢深静脉血栓以及肺栓塞(PE)的体征和症状,如果发现需要立即行双侧下肢深静脉彩色多普勒超声检查,术后第7天常规进行双下肢静脉彩色多普勒超声检查,出院后随访至术后30天,记录三组术后30天内的DVT形成情况及术后DVT发生率,记录围手术期间显性失血量,同时记录出血征象,通过对每组DVT发生率、安全性指标的对比分析获得利伐沙班联合使用间歇充气加压装置不同方法和方式的有效性及安全性。结果 A组术后2例出现DVT(4.0%),围手术期间显性失血量692.7±124.9;B组术后2例出现DVT(4.0%),围手术期间显性失血量599.5±133.2；C组术后8例出现DVT(16.0%)。围手术期间显性失血量(毫升m1)553.5±126.4,对于DVT发生率比较,A组、B组明显低于C组(P0.05),而第A、B组相互比较差异均无统计学意义(P0.05)。围手术期间显性失血量：A组与B、C组相比较差异有统计学意义(P0.05),B与C组间比较时,差异无统计学意义(P0.05)。三组术后均没有发生皮肤粘膜出血和血肿等并发症,仅A组有一例牙龈出血征象。结论 IPC在麻醉时使用对预防DVT具有良好的效果；术前及术后开始口服利伐沙班对于预防DVT没有明显差别,术前口服利伐沙班增加了围手术期间出血量；术后一月仍有出现DVT的风险。
[Abstract]:Background because deep vein thrombosis of lower extremity is one of the most common complications after artificial joint replacement, relevant studies have shown that, without effective preventive measures, The incidence of deep vein thrombosis in patients after hip surgery can be as high as 45% and 75 75%. The incidence of pulmonary thromboembolism is about 0.1% and 2.0%. Deep vein thrombosis causes very serious damage to the body. The combined use of anticoagulants and mechanical prophylaxis is recommended by experts at home and abroad. Therefore, it is important to explore the combination of anticoagulants and intermittent inflatable pressure devices in different periods to prevent deep venous thrombosis of lower extremity after arthroplasty. Objective to compare the effect and perioperative bleeding of deep vein thrombosis (DVT) of lower extremity after artificial hip arthroplasty by using Levashaban and intermittent inflatable compression device (IPC). To explore a new effective and safe method to prevent deep venous thrombosis after arthroplasty. Methods from September 2013 to March 2014, 150 patients with artificial hip replacement were randomly divided into group A (n = 50) and group A (n = 50). The patients were given orally for 12 hours before operation (10g/ day), and 50 patients in group B were treated with IPCG B at the beginning of anesthesia. After 10 hours of operation, rivastabine (10g/ day) was taken orally. 50 patients in group C were treated with IPC-C at the beginning of anesthesia. After 10 hours of operation, livashaban (10g/ day) was given orally, and IPC-C was used after operation. There was no significant difference in sex, height, age, weight and course of disease among the three groups (p0.05). The three groups of patients were basically the same in terms of preparation before operation and medication after operation. In order to ensure the consistency of surgical procedures as much as possible, all patients were operated by the same group of doctors in our hospital. Postoperative routine observation of patients with lower extremity deep venous thrombosis and pulmonary embolism (PE) signs and symptoms, if found to need to be immediately bilateral deep vein color Doppler ultrasound examination, On the 7th day after operation, both lower extremity veins were examined by color Doppler ultrasonography, followed up to 30 days after discharge. The formation of DVT and the incidence of postoperative DVT were recorded in the three groups, and the amount of dominant blood loss during perioperative period was recorded. At the same time, the bleeding signs were recorded, and the effectiveness and safety of different methods and methods of combined use of Levashaban with intermittent inflatable pressure device were obtained by comparing and analyzing the incidence and safety of DVT in each group. Results DVT was found in 2 cases (4.0%) in group A, 2 cases (4.0%) in group B and 8 cases (16.0%) in group C during perioperative period. The apparent blood loss (ml M1) was 553.5 卤126.4 in perioperative period. The incidence of DVT in group A was significantly lower than that in group C (P0.05), but there was no significant difference between group A and group B (P0.05). There was no significant difference in the apparent blood loss between group A and group C (P0.05) during perioperative period (P0.05) between group B and group C. there was no significant difference between group B and group C (P0.05). There were no complications such as skin and mucosal hemorrhage and hematoma in all three groups, but only one case in group A had gingival bleeding. Conclusion IPC has a good effect on the prevention of DVT during anaesthesia, and there is no significant difference in the prevention of DVT by oral rivastabine before and after operation, and the amount of bleeding during perioperative period is increased by oral rivastaban before and after operation. There is still a risk of DVT one month after surgery.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4

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