CAJ | 학술논문

目的探讨利伐沙班联合气压对老年股骨粗隆间骨折PFNA固定术后预防下肢深静脉血栓形成的效果.方法老年股骨粗隆间骨折PFNA术后患者80例术前,术后第2、7 d凝血指标(D-二聚体等)及术后第2、7、14 d肢体肿胀程度评分,并常规术后第7、14 d行双下肢深静脉彩色多普勒超声检查,所获数据采用方差分析和t检验.结果有5例发生双下肢深静脉血栓形成事件,治疗组发生1例,发生率为2.5%,对照组共有4例发生,发生率为10%,两组深静脉血栓发生率的比较差异具有显著性(P<0.05).两组患者术前D-二聚体的比较差异无显著性(P>0.05),但术后第2、7天D-二聚体的变化比较差异有显著性(P<0.05);两组患者术前及术后第2 d肢体肿胀的评分比较无明显差异(P>0.05);术后第7、14 d肢体肿胀的评分比较有明显差异(P<0.05).结论利伐沙班联合气压治疗组预防老年股骨粗隆间骨折PFNA固定术后双下肢深静脉血栓形成的发生率低于单纯给药利伐沙班未联合气压治疗的患者,治疗前后两组的凝血功能比较有显著性差异.利伐沙班用药安全性高,辅助气压治疗后具有更加确切的疗效,可作为临床预防双下肢深静脉血栓形成的常规治疗措施.
목적 탐토리벌사반연합기압대노년고골조륭간골절PFNA고정술후예방하지심정맥혈전형성적효과.방법 노년고골조륭간골절PFNA술후환자80례술전,술후제2、7 d응혈지표(D-이취체등)급술후제2、7、14 d지체종창정도평분,병상규술후제7、14 d행쌍하지심정맥채색다보륵초성검사,소획수거채용방차분석화t검험.결과 유5례발생쌍하지심정맥혈전형성사건,치료조발생1례,발생솔위2.5%,대조조공유4례발생,발생솔위10%,량조심정맥혈전발생솔적비교차이구유현저성(P<0.05).량조환자술전D-이취체적비교차이무현저성(P>0.05),단술후제2、7천D-이취체적변화비교차이유현저성(P<0.05);량조환자술전급술후제2 d지체종창적평분비교무명현차이(P>0.05);술후제7、14 d지체종창적평분비교유명현차이(P<0.05).결론 리벌사반연합기압치료조예방노년고골조륭간골절PFNA고정술후쌍하지심정맥혈전형성적발생솔저우단순급약리벌사반미연합기압치료적환자,치료전후량조적응혈공능비교유현저성차이.리벌사반용약안전성고,보조기압치료후구유경가학절적료효,가작위림상예방쌍하지심정맥혈전형성적상규치료조시.
Objective Evaluating the feasibility and the effectiveness of the rivaroxaban with pressure treatment for prevention of deep venous thrombosis in aged patients with femoral intertrochanteric fracture after internal fixation with PF-NA through contrasting two experimental groups, one of which accept the rivaroxaban with pressure treatment, another ac-cept the rivaroxaban without pressure treatment. Methods We monitored the coagulation markers(D-dimmer etc) and the score of swollen legs of 80 aged patients with femoral intertrochanteric fracture after internal fixation with PFNA before op-eration and on the second day and the seventh day after operation, and implemented the routine color doppler flow imaging of both lower extremities on the seventh day and the fourteenth day after operation. These results are compared between groups. To observe and compare the incidence rate of DVT between two groups. Results There occurred 5 DVT inci-dents of both lower extremities in total 80 patients after operations. The treatment group had 1 case of DVT with the inci-dence rate of 2.5 percent, while the control group had 4 cases of DVT with the incidence rate of 10 percent. There had been statistical significance on incidence rate of DVT between two groups (P<0. 05). No statistical significance on variation of D-dimmer between two groups before operations(P>0.05),but there had been statistical significance on the second day and the seventh day after operations(P<0.05). There was no statistical significance on the score of swollen legs between two groups before operation and on the second day after operations(P>0.05),but there had been statistical significance on the seventh day and the fourteenth day after operations(P<0.05). Conclusion The incidence rate of DVT of the treat-ment group which accepted both rivaroxaban and pressure treatment in preventing deep venous thrombosis in aged pa-tients with femoral intertrochanteric fracture after internal fixation with PFNA is lower than the control group, which did not accept pressure treatment but rivaroxaban only. There had been statistical significance on variation of coagulation func-tion for two groups before and after treatments. Rivaroxaban is high safe, and it was more effective if assisted with pres-sure treatment. It can be used for clinical applications as the conventional treatment measures in preventing deep venous thrombosis.