本文選題：利伐沙班 + 間歇充氣加壓裝置�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文

【摘要】：背景 由于下肢深靜脈血栓是人工關(guān)節(jié)置換術(shù)后最常見并發(fā)癥之一,相關(guān)研究表明,如果沒有有效的預(yù)防措施,髖關(guān)節(jié)術(shù)后患者深靜脈血栓發(fā)生率可以高達(dá)為45%～75%,肺血栓栓塞癥發(fā)生率約為0.1%～2.0%,深靜脈血栓引起對(duì)機(jī)體的損傷非常嚴(yán)重,抗凝藥物與機(jī)械性預(yù)防的聯(lián)合使用為國(guó)內(nèi)外專家推薦,但相關(guān)文獻(xiàn)報(bào)道不多。因此,探討不同時(shí)期聯(lián)合使用抗凝藥物與間歇充氣加壓裝置對(duì)預(yù)防關(guān)節(jié)置換術(shù)后下肢深靜脈血栓形成有著重要意義。 目的 通過(guò)運(yùn)用人工髖關(guān)節(jié)置換術(shù)后聯(lián)合應(yīng)用利伐沙班及間歇充氣加壓裝置(IPC)不同使用方式,比較預(yù)防人工關(guān)節(jié)置換術(shù)后下肢深靜脈血栓(DVT)的效果和圍手術(shù)期出血量,研究探討預(yù)防人工關(guān)節(jié)置換術(shù)后下肢深靜脈血栓形成有效而又安全的新方法。 方法 2013年9月至2014年3月,150例人工髖關(guān)節(jié)置換手術(shù)病例,隨機(jī)分成3組。A組50例,術(shù)前12小時(shí)即開始口服利伐沙班(10g/天),麻醉開始時(shí)即開始使用IPC;B組50例,術(shù)后10小時(shí)口服利伐沙班(10g/天),麻醉開始時(shí)即使用IPC;C組50例,術(shù)后10小時(shí)后即開始口服利伐沙班(10g/天),術(shù)畢后使用IPC。三組患者分別在性別、身高、年齡、體重及病程等一般資料的比較上,均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。三組患者在手術(shù)前準(zhǔn)備以及術(shù)后用藥上基本一致,為了盡可能保證手術(shù)操作的一致性,所有由本院同一組醫(yī)生進(jìn)行手術(shù)操作,術(shù)后常規(guī)觀察患者有無(wú)下肢深靜脈血栓以及肺栓塞(PE)的體征和癥狀,如果發(fā)現(xiàn)需要立即行雙側(cè)下肢深靜脈彩色多普勒超聲檢查,術(shù)后第7天常規(guī)進(jìn)行雙下肢靜脈彩色多普勒超聲檢查,出院后隨訪至術(shù)后30天,記錄三組術(shù)后30天內(nèi)的DVT形成情況及術(shù)后DVT發(fā)生率,記錄圍手術(shù)期間顯性失血量,同時(shí)記錄出血征象,通過(guò)對(duì)每組DVT發(fā)生率、安全性指標(biāo)的對(duì)比分析獲得利伐沙班聯(lián)合使用間歇充氣加壓裝置不同方法和方式的有效性及安全性。 結(jié)果 A組術(shù)后2例出現(xiàn)DVT(4.0%),圍手術(shù)期間顯性失血量692.7±124.9;B組術(shù)后2例出現(xiàn)DVT(4.0%),圍手術(shù)期間顯性失血量599.5±133.2；C組術(shù)后8例出現(xiàn)DVT(16.0%)。圍手術(shù)期間顯性失血量(毫升m1)553.5±126.4,對(duì)于DVT發(fā)生率比較,A組、B組明顯低于C組(P0.05),而第A、B組相互比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。圍手術(shù)期間顯性失血量：A組與B、C組相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),B與C組間比較時(shí),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三組術(shù)后均沒有發(fā)生皮膚粘膜出血和血腫等并發(fā)癥,僅A組有一例牙齦出血征象。 結(jié)論 IPC在麻醉時(shí)使用對(duì)預(yù)防DVT具有良好的效果；術(shù)前及術(shù)后開始口服利伐沙班對(duì)于預(yù)防DVT沒有明顯差別,術(shù)前口服利伐沙班增加了圍手術(shù)期間出血量；術(shù)后一月仍有出現(xiàn)DVT的風(fēng)險(xiǎn)。
[Abstract]:Background because deep vein thrombosis of lower extremity is one of the most common complications after artificial joint replacement, relevant studies have shown that, without effective preventive measures, The incidence of deep vein thrombosis in patients after hip surgery can be as high as 45% and 75 75%. The incidence of pulmonary thromboembolism is about 0.1% and 2.0%. Deep vein thrombosis causes very serious damage to the body. The combined use of anticoagulants and mechanical prophylaxis is recommended by experts at home and abroad. Therefore, it is important to explore the combination of anticoagulants and intermittent inflatable pressure devices in different periods to prevent deep venous thrombosis of lower extremity after arthroplasty. Objective to compare the effect and perioperative bleeding of deep vein thrombosis (DVT) of lower extremity after artificial hip arthroplasty by using Levashaban and intermittent inflatable compression device (IPC). To explore a new effective and safe method to prevent deep venous thrombosis after arthroplasty. Methods from September 2013 to March 2014, 150 patients with artificial hip replacement were randomly divided into group A (n = 50) and group A (n = 50). The patients were given orally for 12 hours before operation (10g/ day), and 50 patients in group B were treated with IPCG B at the beginning of anesthesia. After 10 hours of operation, rivastabine (10g/ day) was taken orally. 50 patients in group C were treated with IPC-C at the beginning of anesthesia. After 10 hours of operation, livashaban (10g/ day) was given orally, and IPC-C was used after operation. There was no significant difference in sex, height, age, weight and course of disease among the three groups (p0.05). The three groups of patients were basically the same in terms of preparation before operation and medication after operation. In order to ensure the consistency of surgical procedures as much as possible, all patients were operated by the same group of doctors in our hospital. Postoperative routine observation of patients with lower extremity deep venous thrombosis and pulmonary embolism (PE) signs and symptoms, if found to need to be immediately bilateral deep vein color Doppler ultrasound examination, On the 7th day after operation, both lower extremity veins were examined by color Doppler ultrasonography, followed up to 30 days after discharge. The formation of DVT and the incidence of postoperative DVT were recorded in the three groups, and the amount of dominant blood loss during perioperative period was recorded. At the same time, the bleeding signs were recorded, and the effectiveness and safety of different methods and methods of combined use of Levashaban with intermittent inflatable pressure device were obtained by comparing and analyzing the incidence and safety of DVT in each group. Results DVT was found in 2 cases (4.0%) in group A, 2 cases (4.0%) in group B and 8 cases (16.0%) in group C during perioperative period. The apparent blood loss (ml M1) was 553.5 鹵126.4 in perioperative period. The incidence of DVT in group A was significantly lower than that in group C (P0.05), but there was no significant difference between group A and group B (P0.05). There was no significant difference in the apparent blood loss between group A and group C (P0.05) during perioperative period (P0.05) between group B and group C. there was no significant difference between group B and group C (P0.05). There were no complications such as skin and mucosal hemorrhage and hematoma in all three groups, but only one case in group A had gingival bleeding. Conclusion IPC has a good effect on the prevention of DVT during anaesthesia, and there is no significant difference in the prevention of DVT by oral rivastabine before and after operation, and the amount of bleeding during perioperative period is increased by oral rivastaban before and after operation. There is still a risk of DVT one month after surgery.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 殷琦,胡欣,劉蕾,史愛欣,赫廣威,孫春華;低分子肝素鈣注射液人體藥代動(dòng)力學(xué)研究[J];中國(guó)臨床藥理學(xué)雜志;2001年01期

2 許建芬;;梯度彈力襪預(yù)防人工髖關(guān)節(jié)置換術(shù)后深靜脈血栓形成的效果[J];解放軍護(hù)理雜志;2011年16期

3 王廷瑞,王振才,李曉;低分子肝素的藥理特性及臨床應(yīng)用[J];臨床薈萃;2000年18期

4 邵松;尚希福;;下肢深靜脈栓塞預(yù)防的進(jìn)展[J];臨床骨科雜志;2008年06期

5 沈彬;楊靜;裴福興;;骨水泥型全髖置換術(shù)中的嚴(yán)重并發(fā)癥及其防治措施——附433例報(bào)告[J];四川醫(yī)學(xué);2006年06期

6 劉長(zhǎng)城;;應(yīng)用足底靜脈泵或醫(yī)用彈力襪預(yù)防人工關(guān)節(jié)置換術(shù)后下肢深靜脈血栓形成[J];山東醫(yī)藥;2011年28期

7 黃穎;薛柏余;于雪;;壓力抗栓泵輔助預(yù)防老年膝、髖關(guān)節(jié)置換術(shù)后下肢深靜脈血栓形成的臨床研究[J];微創(chuàng)醫(yī)學(xué);2007年03期

8 張黃麗;葛衡江;;血栓彈力圖和D-二聚體在髖關(guān)節(jié)置換術(shù)患者圍術(shù)期的變化[J];武警醫(yī)學(xué)院學(xué)報(bào);2009年04期

9 柳椰;潘梁;;人工關(guān)節(jié)置換后的深靜脈血栓形成[J];中國(guó)組織工程研究與臨床康復(fù);2010年22期

10 黎堅(jiān);;間歇性充氣加壓與髖關(guān)節(jié)置換后下肢深靜脈栓塞的預(yù)防和治療[J];中國(guó)組織工程研究與臨床康復(fù);2010年43期

，

本文編號(hào)：2062992