实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2014年
4期
48-50,53
,共4页
叶庆林%卢伟杰%罗春强%梁桂泉%卢志文
葉慶林%盧偉傑%囉春彊%樑桂泉%盧誌文
협경림%로위걸%라춘강%량계천%로지문
栓塞,血栓,静脉%手术,骨科%利伐沙班%低分子肝素
栓塞,血栓,靜脈%手術,骨科%利伐沙班%低分子肝素
전새,혈전,정맥%수술,골과%리벌사반%저분자간소
embolism,thrombosis,vein%surgery,orthopaedics%rivaroxaban%low molecular weight heparin
目的：探讨利伐沙班预防高龄骨科大手术后静脉血栓栓塞（venous thromboembolism，VTE）的临床疗效和安全性。方法将65例采用股骨近端防旋髓内钉（proximal femoral nail anti-rotation,PFNA）固定的股骨转子间骨折患者按就诊顺序分为2组。治疗组32例，术后口服利伐沙班片；对照组33例，术后采用低分子肝素治疗。测定2组患者的术后出血量，术前及术后12 d血红蛋白量、血小板计数、凝血酶原时间（prothrombin time，PT）及活化部分凝血酶时间（activated partial thromboplastin time，APTT），并于术后12 d 行血管彩色多普勒检察，观察患者是否有DVT 形成；记录2组患者术后12 d内胃肠道出血和血肿等出血事件的发生情况。结果2组患者手术前及术后12 d血红蛋白量、血小板计数、PT及APTT比较，差异均无统计学意义（均P＞0.05）。治疗组患者术后出血量小于对照组（P＝0.001），2组患者DVT发生率比较差异无统计学意义（P＝0.628），治疗组发生胃肠道出血1例，对照组发生胃肠道出血1例、伤口局部血肿1例，2组患者不良反应发生率比较差异无统计学意义（P=1.000）。结论利伐沙班预防高龄股骨转子间骨折PFNA固定手术后VTE的临床疗效优于低分子肝素，安全性与其相当，并且简化了治疗过程，是预防骨科大手术后VTE的有效方法。
目的：探討利伐沙班預防高齡骨科大手術後靜脈血栓栓塞（venous thromboembolism，VTE）的臨床療效和安全性。方法將65例採用股骨近耑防鏇髓內釘（proximal femoral nail anti-rotation,PFNA）固定的股骨轉子間骨摺患者按就診順序分為2組。治療組32例，術後口服利伐沙班片；對照組33例，術後採用低分子肝素治療。測定2組患者的術後齣血量，術前及術後12 d血紅蛋白量、血小闆計數、凝血酶原時間（prothrombin time，PT）及活化部分凝血酶時間（activated partial thromboplastin time，APTT），併于術後12 d 行血管綵色多普勒檢察，觀察患者是否有DVT 形成；記錄2組患者術後12 d內胃腸道齣血和血腫等齣血事件的髮生情況。結果2組患者手術前及術後12 d血紅蛋白量、血小闆計數、PT及APTT比較，差異均無統計學意義（均P＞0.05）。治療組患者術後齣血量小于對照組（P＝0.001），2組患者DVT髮生率比較差異無統計學意義（P＝0.628），治療組髮生胃腸道齣血1例，對照組髮生胃腸道齣血1例、傷口跼部血腫1例，2組患者不良反應髮生率比較差異無統計學意義（P=1.000）。結論利伐沙班預防高齡股骨轉子間骨摺PFNA固定手術後VTE的臨床療效優于低分子肝素，安全性與其相噹，併且簡化瞭治療過程，是預防骨科大手術後VTE的有效方法。
목적：탐토리벌사반예방고령골과대수술후정맥혈전전새（venous thromboembolism，VTE）적림상료효화안전성。방법장65례채용고골근단방선수내정（proximal femoral nail anti-rotation,PFNA）고정적고골전자간골절환자안취진순서분위2조。치료조32례，술후구복리벌사반편；대조조33례，술후채용저분자간소치료。측정2조환자적술후출혈량，술전급술후12 d혈홍단백량、혈소판계수、응혈매원시간（prothrombin time，PT）급활화부분응혈매시간（activated partial thromboplastin time，APTT），병우술후12 d 행혈관채색다보륵검찰，관찰환자시부유DVT 형성；기록2조환자술후12 d내위장도출혈화혈종등출혈사건적발생정황。결과2조환자수술전급술후12 d혈홍단백량、혈소판계수、PT급APTT비교，차이균무통계학의의（균P＞0.05）。치료조환자술후출혈량소우대조조（P＝0.001），2조환자DVT발생솔비교차이무통계학의의（P＝0.628），치료조발생위장도출혈1례，대조조발생위장도출혈1례、상구국부혈종1례，2조환자불량반응발생솔비교차이무통계학의의（P=1.000）。결론리벌사반예방고령고골전자간골절PFNA고정수술후VTE적림상료효우우저분자간소，안전성여기상당，병차간화료치료과정，시예방골과대수술후VTE적유효방법。
Objective To investigate the clinical efficacy and safety of rivaroxaban in the prevention of venous thromboembolism ( VTE ) after major orthopedic surgery in elderly patients . Methods Sixty-five patients who underwent proximal femoral nail anti-rotation (PFNA) fixation for intertrochanteric fracture were orally given either rivaroxaban (treatment group, n=32) or low molecular weight heparin (control group, n=33) after operation. The blood loss was detected before operation. The hemoglobin, platelet count, prothrombin time (PT) and activated partial thromboplastin time (APTT) were determined before and 12 days after operation. Furthermore, deep venous thrombosis (DVT) was observed by color Doppler sonography 12 days after operation. Moreover, gastrointestinal bleeding and hematoma were recorded within 12 days after operation. Results There were no statistical differences in hemoglobin, platelet count, PT and APTT between the two groups before and 12 days after operation (P>0.05). Compared with control group, postoperative blood loss reduced in treatment group(P=0.001).No significant difference in the incidence of DVT was found between the two group (P=0.628). In treatment group, 1 patient had gastrointestinal bleeding. In control group, 1 patient had gastrointestinal bleeding and 1 patient had local wound hematoma. The difference in the incidence of adverse reactions was not significant between the two groups (P=1.000). Conclusion Rivaroxaban is superior to low molecular weight heparin for preventing VTE in elderly patients undergoing PFNA fixation for intertrochanteric fracture. In addition, rivaroxaban has the same safety as low molecular weight heparin. Therefore, rivaroxaban treatment is effective for the prevention of VTE after major orthopedic surgery.
