利伐沙班与低分子肝素对TKA患者术后下肢水肿及炎症反应的影响

发布时间：2018-07-25 12:43

【摘要】：目的:利伐沙班与低分子肝素(low molecular weight heparins,LMWHs)是全膝关节置换术(totalknee arthroplasty,TKA)后经常使用的两种抗凝药物,主要用来预防下肢深静脉血栓(deep venous thrombosis,DVT)的形成。国内外学者针对这两种药物进行了大量的临床实验研究,普遍认为利伐沙班的抗凝效果更好,且安全性与低分子肝素相似,是预防TKA术后DVT的首选用药。但是,在使用利伐沙班或低分子肝素预防TKA术后血栓的过程中,经常会出现过度抗凝,并造成隐性失血增加等现象。同时外渗的血液进入周围组织间隙和死腔,其中的红细胞发生溶血反应,进一步的加重了术后下肢水肿与炎症反应,严重的影响了患者术后康复,并延长了住院周期。因此,本实验的目的为通过随机对照实验,来对比分析利伐沙班与低分子肝素这两种药物对TKA患者术后的水肿及炎症反应所造成的影响是否存在差异。进而为关节外科医师在预防TKA术后下肢深静脉血栓的选择用药中提供一定的参考意见。方法:实验对象为2016年8月份至2017年1月份于山东省立医院关节外科接受单侧TKA治疗的患者(n=41),年龄介于51岁与83岁之间(年龄中位数=67),从术后第一天开始随机使用拜瑞妥(n=22)或齐征(n=19)预防血栓栓塞,使用方法分别为1Omgp.o.qd和0.4mlH.qd,连续使用至术后第35天。实验过程中连续监测患者术前1天至术后7天内的患肢皮温、水肿程度(髌骨上、下15cm处的周径)以及术后第1天、第3天和第7天的ESR、CRP和IL-6的数值,最后通过重复测量设计资料的方差分析来检验利伐沙班与低分子肝素对术后下肢水肿及炎症反应所造成的影响有无差异(置信区间CI=95%)。结果:利伐沙班实验组患者术后每日的皮温、水肿程度和ESR、CRP、IL-6的数值比低分子肝素钠实验组略有升高,但升高数值不大,差距不明显。对以上几项监测指标进行的统计分析显示,P值0.05。说明利伐沙班与低分子肝素钠对患者术后水肿及炎症反应所造成的影响并无显著的统计学差异。对患者下肢皮温与水肿程度进行Spearman相关性分析后显示,P值0.05,说明皮温与水肿程度呈正相关。结论:利伐沙班与低分子肝素钠对单膝关节置换术后患者的下肢水肿及炎症反应所造成的影响相同。
[Abstract]:Objective: Levashaban and low molecular weight heparins (low molecular weight heparinsus LMWHs) are two kinds of anticoagulants frequently used after totalknee arthroplasty (TKA), which are mainly used to prevent the formation of (deep venous thromboembolism (DVT) in deep vein thrombosis of lower extremity. Scholars at home and abroad have carried out a large number of clinical experimental studies on these two drugs. It is generally considered that the anticoagulant effect of rivastaban is better and the safety is similar to that of low molecular weight heparin (LMWH), so it is the first choice to prevent DVT after TKA. However, in the course of preventing thrombus after TKA, excessive anticoagulant and increased recessive blood loss often occur in the course of using livasaban or low-molecular-weight heparin (LMWH). At the same time, the exosmosis blood entered the surrounding tissue space and the dead cavity, and the erythrocyte hemolysis reaction occurred, which further aggravated the edema and inflammation of the lower extremities after operation, seriously affected the patient's recovery after operation, and prolonged the hospitalization period. Therefore, the purpose of this study was to compare the effects of livasaban and low-molecular-weight heparin on edema and inflammation in patients with TKA by a randomized controlled trial. It provides some reference for joint surgeons in the prevention of lower extremity deep vein thrombosis after TKA. Methods: the subjects were selected from August 2016 to January 2017 who were treated with unilateral TKA at the Department of Arthroplasty, Shandong Provincial Hospital (NX41), aged between 51 and 83 years (median age 67). To prevent thromboembolism with Bayretol (nnm22) or monomorphism (nm19), 1Omgp.o.qd and 0.4ml H. QD were used continuously until the 35th day after operation. The skin temperature, edema (the circumference of upper and lower patella 15cm), and the values of ESR-CRP and IL-6 on the 1st, 3rd and 7th day after operation were monitored continuously during the first day of operation and 7 days after operation. Finally, the variance analysis of repeated measurement data was used to examine whether there was any difference in the effect of Levashaban and low molecular weight heparin on edema and inflammation of lower extremities after operation (confidence interval CI95%). Results: compared with low molecular weight heparin (LMWH) group, the daily skin temperature, edema degree and ESR-CRPU IL-6 increased a little in livasaban group, but the difference was not significant. The statistical analysis of the above monitoring indexes showed that P value was 0.05. The results showed that there was no significant difference in the effect of livasaban and low molecular weight heparin sodium on postoperative edema and inflammatory reaction. The correlation analysis of Spearman between skin temperature and edema degree of lower extremity showed that P value was 0. 05, indicating that there was a positive correlation between skin temperature and edema degree. Conclusion: Levashaban and low molecular weight heparin sodium have the same effect on edema and inflammation of lower extremity after single knee joint replacement.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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