脊柱术后应用抗凝药物预防深静脉血栓安全性的相关研究

发布时间：2018-09-11 16:17

【摘要】：目的探讨脊柱疾病患者术后深静脉血栓的成因、发生概率以及术后应用利伐沙班(Rivaroxaban)预防下肢深静脉血栓形成的安全性和有效性。资料与方法选取于2012年11月至2013年10月在青岛大学医学院附属医院脊柱外科接受腰椎手术治疗的成年患者共120例。其中男性76例,女性44例,平均年龄57.1岁(最小20岁,最大81岁)。将上述所有患者按随机原则分为对照组和实验组,每组60例。对照组：患者术后均未应用任何药物或机械方式抗凝预防深静脉血栓。实验组：患者手术后第一天晨起开始口服利伐沙班(10mg/qd)抗凝预防深静脉血栓治疗,下地活动1周后停止服药；上述所有实验组和对照组患者平素无血液系统疾病,凝血机制正常,既往无脑血栓、脑梗塞等血栓栓塞性疾病病史,术前未口服或静脉应用任何抗凝药物。麻醉方法均采用全身麻醉。所有病例均术前术后测定凝血酶原时间、血红蛋白、D-二聚体、血小板、肝功能(谷丙转氨酶、谷草转氨酶)等血液指标；记录手术中的失血量及术后切口引流管的引流量；术前及术后1周行双下肢血管彩色超声检查；观察有无临床血栓栓塞症状出现。观察手术后切口情况及有无手术相关并发症出现。出院后所有患者随访1个月。结果实验组及对照组所有患者有效病例117例,其中对照组58例,实验组59例。对照组有7例患者在术后先后出现下肢深静脉血栓形成,发生率为12.1%(7/58),其中有症状型1例,为肺栓塞(PE),患者经抢救无效死亡,发生率及死亡率为1.7%(1/58),无症状型6例,发生率10.4%(6/58)；实验组出现下肢深静脉血栓形成患者1例,发生率1.7(1/59),无肺栓塞及死亡病例；将上述两组结果进行对比,发现两组患者深静脉血栓的发生率有明显的统计学意义(P0.05)。两组病例在术后第1、4、7天进行血小板、纤维蛋白原、血浆D-二聚体、凝血酶原时间检查,术后1周行肝功能(谷丙转氨酶、谷草转氨酶)检查,将两组间结果进行统计学分析。实验组2例患者出现出血相关并发症,黑便患者1例,切口皮下轻度淤血1例,上述两例患者停药后症状即减轻、消失,至出院未发生DVT。其余实验组患者以及对照组患者均未出现皮下淤血、黑便、硬膜外血肿、血尿、牙龈出血等出血相关并发症。在出血风险方面,两组进行比较无明显统计学差异(P0.05)。两组病例患者术后随访1月,均恢复良好,未发现因出血性疾病导致再次住院治疗的病例。结论在不增加术后出血的前提下,脊柱手术后早期即应用利伐沙班进行抗凝治疗能够明显降低术后深静脉血栓的发生,尤其是对需要长时间卧床的患者效果更加显著。
[Abstract]:Objective to investigate the causes and probability of deep venous thrombosis (DVT) in patients with spinal diseases after operation and the safety and efficacy of Levasaban (Rivaroxaban) in preventing deep venous thrombosis (DVT) of lower extremity. Materials and methods from November 2012 to October 2013, 120 adult patients were treated with lumbar spine surgery in the affiliated Hospital of Qingdao University Medical College. There were 76 males and 44 females with an average age of 57.1 years (the youngest 20 years, the maximum 81 years). All the patients were randomly divided into control group and experimental group with 60 cases in each group. Control group: no drug or mechanical anticoagulant was used to prevent deep venous thrombosis. Experimental group: the patients began to take oral anticoagulant therapy (10mg/qd) to prevent deep venous thrombosis from the first day after operation, and stopped taking drugs after 1 week of ground exercise. All the patients in the experimental group and control group had no hematological diseases, and the coagulation mechanism was normal. No previous history of thromboembolic diseases such as cerebral thrombosis, cerebral infarction, no preoperative oral or intravenous use of any anticoagulants. General anesthesia was used in all anesthesia methods. The prothrombin time, hemoglobin D-dimer, platelet, liver function (alanine aminotransferase, alanine aminotransferase) were measured before and after operation. Before and 1 week after operation, both lower extremities were examined by color ultrasound and clinical thromboembolism was observed. To observe the postoperative incision and the occurrence of surgical complications. All patients were followed up for 1 month after discharge. Results there were 117 effective cases in the experimental group and control group, including 58 cases in the control group and 59 cases in the experimental group. In the control group, 7 patients (12. 1%) developed deep vein thrombosis (7 / 58), and 1 case (1 / 58) had symptomatic type. The death rate and mortality were 1.7% (1 / 58) and 10. 4% (6 / 58) respectively in the patients with pulmonary embolism (PE),). There was no pulmonary embolism and death in the experimental group (1 / 59). The results of the above two groups were compared, and the incidence of deep venous thrombosis in the two groups was statistically significant (P0.05). The platelet, fibrinogen, plasma D-dimer and prothrombin time were examined in both groups on the 7th day after operation. The liver function (alanine aminotransferase, alanine aminotransferase) was examined 1 week after operation, and the results between the two groups were analyzed statistically. Two patients in the experimental group had bleeding related complications, one patient had black stool, and one patient had mild congestion under the incision. The symptoms of the two patients were alleviated and disappeared, and no DVT. occurred until discharge from hospital. There were no bleeding related complications such as subcutaneous congestion, black stool, epidural hematoma, hematuria, gingival hemorrhage and so on. In the risk of bleeding, there was no significant difference between the two groups (P0.05). The patients in both groups were followed up for 1 month and recovered well. No rehospitalization due to hemorrhagic disease was found in the two groups. Conclusion the anticoagulant therapy of rivastaban in the early stage of spinal surgery without increasing postoperative bleeding can significantly reduce the incidence of postoperative deep venous thrombosis, especially for patients who need to stay in bed for a long time.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

【参考文献】