CAJ | 학술논문

目的：探索髋膝关节置换围手术期下肢深静脉血栓形成与 D-二聚体升高关系及使用不同抗凝药的有效性和安全性评估。方法前瞻性分析70例行髋膝关节置换的患者，根据术后双下肢彩色多普勒超声结果，分为血栓组（11例）和非血栓组（59例），记录两组在术前及术后D-二聚体浓度并进行统计分析。同时按照使用抗凝药不同分为低分子肝素（速碧林）预防组和利伐沙班预防组，记录并比较二者DVT发生率和术后伤口引流量关系。结果血栓组术前D-二聚体浓度与非血栓组术前D-二聚体的浓度相比较有显著性差异（P＜0.01），血栓组较非血栓组增高。血栓组与非血栓组术后第7天的D-二聚体浓度比较则无显著性差异（P＞0.05），血栓组与非血栓组各自组内比较，术后与术前的D-二聚体浓度比较均有显著性差异（P＜0.01），术后浓度较术前均有增高。在使用抗凝药物情况下DVT的发病率为15.71％，利伐沙班与低分子肝素（速碧林）干预后DVT发生的情况无显著性差异（ P＞0.05）。术后伤口引流量无统计学差异（ P＞0.05）。结论研究发现D-二聚体对DVT预测不是特异性指标；髋膝关节置换术后使用抗凝药物情况下 DVT发生情况明显下降，利伐沙班与低分子肝素对于预防DVT作用上无显著性差异。
목적：탐색관슬관절치환위수술기하지심정맥혈전형성여 D-이취체승고관계급사용불동항응약적유효성화안전성평고。방법전첨성분석70례행관슬관절치환적환자，근거술후쌍하지채색다보륵초성결과，분위혈전조（11례）화비혈전조（59례），기록량조재술전급술후D-이취체농도병진행통계분석。동시안조사용항응약불동분위저분자간소（속벽림）예방조화리벌사반예방조，기록병비교이자DVT발생솔화술후상구인류량관계。결과혈전조술전D-이취체농도여비혈전조술전D-이취체적농도상비교유현저성차이（P＜0.01），혈전조교비혈전조증고。혈전조여비혈전조술후제7천적D-이취체농도비교칙무현저성차이（P＞0.05），혈전조여비혈전조각자조내비교，술후여술전적D-이취체농도비교균유현저성차이（P＜0.01），술후농도교술전균유증고。재사용항응약물정황하DVT적발병솔위15.71％，리벌사반여저분자간소（속벽림）간예후DVT발생적정황무현저성차이（ P＞0.05）。술후상구인류량무통계학차이（ P＞0.05）。결론연구발현D-이취체대DVT예측불시특이성지표；관슬관절치환술후사용항응약물정황하 DVT발생정황명현하강，리벌사반여저분자간소대우예방DVT작용상무현저성차이。
Objective To explore the relationship between D-dimer and the perioperative deep vein thrombosis ( DVT) and to analyze the efficacy and safety of rivaroxaban versus low molecular weight heparin (LMWH) for the prevention of DVT after primary total hip or knee arthroplasty .Methods A prospective analysis was carried out on 70 patients.The patients were divided into two groups according to the results of ultrasound for bilateral venae profundae of both the lower extremities on the 7th day after the surgery: the thrombus group and the non-thrombus group . The preoperative and postoperative concentrations of D-dimer were detected and analysed .Meanwhile all the patients were divided into the rivaroxaban group and the LMWH group according to the anticoagulants that were adopted .The incidence of DVT and the drainage volume of the two groups were measured and compared respectively .Results There was significant difference in the preoperative concentration of D-dimer between the thrombus group and the non-thrombus group ( P<0.01) and there was no significant difference in the postoperative concentration of D-dimer 7 days after the operation between the two groups (P>0.05).Comparing the preoperative and the postoperative concentrations of D-dimer, there were significant differences in both the thrombus group and the non-thrombus group ( P<0.01 ) .The postoperative concentration of D-dimer was significantly higher than the preoperative one in both the two groups .As all the patients were taking anticoagulant drugs , the incidence of DVT was 15.71%.There was no significant difference in the incidence of DVT between the rivaroxaban group and the LMWH group ( P >0.05 ); also there was no significant difference in the drainage volume of the two groups ( P>0.05 ) .Conclusions D-dimer is not a specific indicator for the prediction of DVT .The incidence of DVT may decrease significantly when using anticoagulant drugs after primary total hip or knee arthroplasty .The effecacy of DVT prevention shows no difference in rivaroxaban and LMWH.