标题：利伐沙班与依诺肝素钠对髋膝关节置换术后下肢深静脉血栓形成及围手术期隐性失血的影响

      作者：王大城，郭汉明，黄杰华    (惠州市中心人民医院骨科，广东 惠州 516000)

      卷次： 2017年28卷5期

      【摘要】 目的 探讨利伐沙班与依诺肝素钠对髋膝关节置换术(HKJR)后下肢深静脉血栓形成及围手术期隐性失血的影响。方法 选择2013年9月至2015年8月在我院骨科进行HKJR手术治疗的关节置换患者350例进行研究。根据简单数字随机表法将患者分为观察组和对照组，每组175例，两组患者均常规进行手术治疗，术后观察组给予利伐沙班治疗，而对照组给予依诺肝素钠治疗，在治疗14 d后比较两组患者的失血情况，以及血小板(PLT)、活化部分凝血活酶时间(APTT)及D-二聚体(D-D)水平，随访12个月后比较两组的血栓发生率。结果 观察组患者的隐性失血量和总失血量分别为(584.33±210.27) mL和(1 506.37±317.84) mL，均明显大于对照组的(396.28±183.45) mL和(1 265.29±320.52) mL，差异均有统计学意义(P<0.05)；两组患者治疗前后的Plt、APTT及D-D水平比较，差异均无统计学意义(P>0.05)；根据Kaplan-Meier曲线分析可知，观察组患者随访 12个月的血栓发生率为5.16%，明显低于对照组的10.94%，差异有统计学意义(P<0.05)。结论 利伐沙班对髋膝关节置换术围术期造成的术后下肢深静脉血栓发生率更低，虽然隐性失血较依诺肝素钠较高，但二者对凝血功能的影响不大，值得重视。
      【关键词】 利伐沙班；依诺肝素钠；髋膝关节置换术；下肢深静脉血栓；围手术期；隐性失血
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350(2017)05—0752—03

Influence of rivaroxaban versus enoxaparin sodium on lower extremity deep venous thrombosis andperioperative recessive blood loss after hip and knee joint replacement.
WANG Da-cheng, GUO Han-ming, HUANGJie-hua. Huizhou Municipal Central Hospital, Huizhou 516000, Guangdong, CHINA
【Abstract】 Objective To discuss the influence of rivaroxaban versus enoxaparin sodium on lower extremity deepvenous thrombosis and perioperative recessive blood loss after hip and knee joint replacement (HKJR). Methods FromSeptember 2013 to August 2015, 350 patients who underwent HKJR in our hospital were studied. The patients were di-vided into the observation group and the control group according to random number table, with 175 cases in each group.All the patients received conventional surgical treatment. After surgery, the patients in the observation group were givenrivaroxaban, while the patients in the control group were given enoxaparin sodium, for 14 days. The blood loss, platelet(PLT), activation partial thromboplastin time (APTT), D-dimer (D-D) levels, and the incidence of thrombosis were com-pared between the two groups after 12 months of follow-up. Results The recessive blood loss and total blood loss ofthe observation group were (584.33 ± 210.27) mL and (1 506.37 ± 317.84) mL, which were significantly greater than(396.28±183.45) mL and (1 265.29±320.52) mL in the control group, P<0.05. There was no significant difference in thelevels of D-D, APTT and PLT between the two groups before and after treatment (P>0.05). According to Kaplan-Meiercurve, the incidence of thrombosis during 12 months of follow-up in the observation group was 5.16%, which was signif-icantly lower than 10.94% in the control group (P<0.05). Conclusion Rivaroxaban results in lower extremity deep ve-nous thrombosis rate after hip and knee joint replacement and greater perioperative recessive blood loss, compared withenoxaparin sodium, but the influence on blood coagulation function is not significant.
      【Key words】 Rivaroxaban; Enoxaparin sodium; Hip and knee joint replacement; Lower extremity deep venousthrombosis; Perioperative period; Recessive blood loss·论 著·doi:10.3969/j.issn.1003-6350.2017.05.022基金项目：广东省医学科研基金(编号：B2013401)