CAJ | 학술논문

目的前瞻性比较髋关节置换术后短期抗凝与延长抗凝对于患者凝血指标的影响.方法选取2012年6月至2013年5月在北京大学人民医院骨关节病诊疗研究中心行人工全髋关节置换术患者40例,术前采用电脑数字随机分组法随机分组.短期抗凝组和延长抗凝组各20例,并辅以常规物理预防措施.主要观察指标包括凝血酶-抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段F1+2(F1+2)、纤维蛋白原(Fib)及D-二聚体(D-dimer).各项凝血标志物分别于术前48 h内及术后第1、7、35天进行检测;所有患者于术前48 h内及术后第7、35天进行双下肢静脉彩超检查明确有无静脉血栓形成.结果 40例患者超声检查均未发现下肢静脉血栓形成.两组患者术后TAT、F1+2、FIB及D-dimer水平在各检测时间点较术前均有增高.TAT及D-dimer浓度峰值出现在术后第1天,而F1+2及Fib浓度峰值则出现在术后第7天.组间比较,在术后第35天,长期抗凝组的F1+2及TAT水平均低于短期抗凝组,差异有统计学意义(P<0.05).结论人工全髋关节置换术后高凝状态可持续至术后35 d;延长抗凝时限虽不能完全消除高凝状态,但可以减轻术后高凝状态的程度.但基于超声检查,本研究中短期抗凝与延长抗凝对于降低术后下肢深静脉血栓的发生率不能得出明确结论.
목적 전첨성비교관관절치환술후단기항응여연장항응대우환자응혈지표적영향.방법 선취2012년6월지2013년5월재북경대학인민의원골관절병진료연구중심행인공전관관절치환술환자40례,술전채용전뇌수자수궤분조법수궤분조.단기항응조화연장항응조각20례,병보이상규물리예방조시.주요관찰지표포괄응혈매-항응혈매Ⅲ복합물(TAT)、응혈매원편단F1+2(F1+2)、섬유단백원(Fib)급D-이취체(D-dimer).각항응혈표지물분별우술전48 h내급술후제1、7、35천진행검측;소유환자우술전48 h내급술후제7、35천진행쌍하지정맥채초검사명학유무정맥혈전형성.결과 40례환자초성검사균미발현하지정맥혈전형성.량조환자술후TAT、F1+2、FIB급D-dimer수평재각검측시간점교술전균유증고.TAT급D-dimer농도봉치출현재술후제1천,이F1+2급Fib농도봉치칙출현재술후제7천.조간비교,재술후제35천,장기항응조적F1+2급TAT수평균저우단기항응조,차이유통계학의의(P<0.05).결론 인공전관관절치환술후고응상태가지속지술후35 d;연장항응시한수불능완전소제고응상태,단가이감경술후고응상태적정도.단기우초성검사,본연구중단기항응여연장항응대우강저술후하지심정맥혈전적발생솔불능득출명학결론.
Objective To compare the effects of short-term and long-term thromboprophylaxis after total hip replacement on coagulation indicators in plasma sampled before and 1, 7 and 35 days post-operation. Methods A total of 40 patients scheduled for elective total hip replacement were randomly assigned into the short-term (n=20) or long-term (n=20) thromboprophylaxis groups on oral rivaroxaban 10 mg once daily for 7 or 35 days. The primary efficacy hemostatic variables included thrombin-antithrombin complexes (TAT), prothrombin fragment 1+2 (F1t2), D-dimer and fibrinogen (Fib) preoperatively and at Days 1, 7 and 35 postoperatively. And ultrasonography was performed on all patients preoperatively and at days 7 and 35 postoperatively to exclude deep vein thrombosis of lower extremities. Results None of them had deep vein thrombosis (DVT) of lower extremities. Among them, TAT, F1+2, D-dimer and Fib post-operation were higher than those preoperative baseline values. TAT and D-dimer peaked at day 1 postoperatively while the peaks of F1+2 and Fib appeared at day 7 postoperatively. At Day 35 post-operation, the levels of TAT and F1+2 in the long-term thromboprophylaxis group were significantly lower than those of the short-term thromboprophylaxis group (P<0.05). Conclusion The status of hypercoagulability may sustain at least 35 days after total hip replacement. Though not completely eliminated, it can still be reduced by prolonged thromboprophylaxis. However, according to ultrasonography, the effects of short-term and long-term thromboprophylaxis on the incidence rate of DVT remain to be further explored.