初次全膝关节置换术围手术期应用利伐沙班与阿哌沙班抗凝治疗的研究

发布时间：2018-07-20 12:15

【摘要】：目的探讨低分子肝素钙、利伐沙班和阿哌沙班对初次人工全膝关节置换术围手术期抗凝治疗的疗效及其并发症。方法2014年4月—9月,行初次人工全膝关节置换术的60例膝关节骨性关节炎的患者,进行随机分组,即低分子肝素钙组、利伐沙班组和阿哌沙班组,每组20例。根据围手术期红细胞比容计算隐性失血量;监测三组患者术前和术后1天、3天、5天,血常规和术侧髌上10cm及髌下10cm肢体周径变化。分析三组药物对患者围手术期隐性失血、大出血事件、非严重出血、输血需求、凝血功能的变化、肝肾功能的变化、术后切口感染、深静脉血栓形成、肺栓塞等的影响。结果三组术后隐性失血量分别为937.4±308.7ml、887.8±311.4ml、889.8±296.9ml,无显著性差异,P0.05。三组中的无血栓组,隐性失血与术侧下肢髌上及髌下肢体周径变化有相关性,具有统计学意义,P0.05。三组术侧下肢髌上肢体周径变化值存在差异,具有统计学意义,P0.05。三组深静脉血栓形成、肺栓塞等并发症的发生率无显著性差异,P0.05。结论接受初次全膝关节置换术的患者,分别应用低分子肝素钙、利伐沙班和阿哌沙班预防性抗凝,都能够有效预防VTE的发生,且对术后并发症的影响无明显差异,其有效性和安全性相当。但低分子肝素钙相对于利伐沙班、阿哌沙班会增加术侧下肢肢体肿胀程度。
[Abstract]:Objective to evaluate the efficacy and complications of low molecular weight heparin calcium (LMWH), rivastabine and piperazabine in the perioperative treatment of primary total knee arthroplasty. Methods from April to September, 2014, 60 patients with osteoarthritis of knee joint underwent the first total knee arthroplasty. They were randomly divided into three groups: low molecular weight heparin calcium group, rivastaban group and piperzapan group, 20 cases in each group. The recessive blood loss was calculated according to the specific volume of erythrocyte in perioperative period, and the changes of blood routine and limb circumference of suprapatellar 10cm and subpatellar 10cm were monitored before and 1 day after operation. The effects of three groups of drugs on recessive hemorrhage, massive hemorrhage, non-severe hemorrhage, blood transfusion demand, changes of coagulation function, changes of liver and kidney function, postoperative wound infection, deep vein thrombosis and pulmonary embolism were analyzed in three groups. Results the occult blood loss in the three groups was 937.4 卤308.7 ml, 887.8 卤311.4 ml, 889.8 卤296.9 ml, respectively (P 0.05). The recessive blood loss was correlated with the changes of peripatellar diameter of the upper patellar and subpatellar limbs in the three groups with statistical significance (P0.05). There was significant difference in peripatellar diameter between the three groups (P 0.05). There was no significant difference in the incidence of complications such as deep venous thrombosis and pulmonary embolism among the three groups (P 0.05). Conclusion low molecular weight heparin calcium, rivastabine and piperazabine can effectively prevent the occurrence of VTE in patients undergoing primary total knee arthroplasty, and there is no significant difference in postoperative complications. Its effectiveness and safety are equal. Low molecular weight heparin calcium (LMWH), compared with rivasaban, increased the swelling of the lower extremity of the operative side.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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