【摘要】：目的探討脊柱疾病患者術(shù)后深靜脈血栓的成因、發(fā)生概率以及術(shù)后應(yīng)用利伐沙班(Rivaroxaban)預(yù)防下肢深靜脈血栓形成的安全性和有效性。 資料與方法選取于2012年11月至2013年10月在青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院脊柱外科接受腰椎手術(shù)治療的成年患者共120例。其中男性76例,女性44例,平均年齡57.1歲(最小20歲,最大81歲)。將上述所有患者按隨機原則分為對照組和實驗組,每組60例。對照組：患者術(shù)后均未應(yīng)用任何藥物或機械方式抗凝預(yù)防深靜脈血栓。實驗組：患者手術(shù)后第一天晨起開始口服利伐沙班(10mg/qd)抗凝預(yù)防深靜脈血栓治療,下地活動1周后停止服藥；上述所有實驗組和對照組患者平素?zé)o血液系統(tǒng)疾病,凝血機制正常,既往無腦血栓、腦梗塞等血栓栓塞性疾病病史,術(shù)前未口服或靜脈應(yīng)用任何抗凝藥物。麻醉方法均采用全身麻醉。所有病例均術(shù)前術(shù)后測定凝血酶原時間、血紅蛋白、D-二聚體、血小板、肝功能(谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶)等血液指標(biāo)；記錄手術(shù)中的失血量及術(shù)后切口引流管的引流量；術(shù)前及術(shù)后1周行雙下肢血管彩色超聲檢查；觀察有無臨床血栓栓塞癥狀出現(xiàn)。觀察手術(shù)后切口情況及有無手術(shù)相關(guān)并發(fā)癥出現(xiàn)。出院后所有患者隨訪1個月。 結(jié)果實驗組及對照組所有患者有效病例117例,其中對照組58例,實驗組59例。對照組有7例患者在術(shù)后先后出現(xiàn)下肢深靜脈血栓形成,發(fā)生率為12.1%(7/58),其中有癥狀型1例,為肺栓塞(PE),患者經(jīng)搶救無效死亡,發(fā)生率及死亡率為1.7%(1/58),無癥狀型6例,發(fā)生率10.4%(6/58)；實驗組出現(xiàn)下肢深靜脈血栓形成患者1例,發(fā)生率1.7(1/59),無肺栓塞及死亡病例；將上述兩組結(jié)果進(jìn)行對比,發(fā)現(xiàn)兩組患者深靜脈血栓的發(fā)生率有明顯的統(tǒng)計學(xué)意義(P0.05)。兩組病例在術(shù)后第1、4、7天進(jìn)行血小板、纖維蛋白原、血漿D-二聚體、凝血酶原時間檢查,術(shù)后1周行肝功能(谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶)檢查,將兩組間結(jié)果進(jìn)行統(tǒng)計學(xué)分析。實驗組2例患者出現(xiàn)出血相關(guān)并發(fā)癥,黑便患者1例,切口皮下輕度淤血1例,上述兩例患者停藥后癥狀即減輕、消失,至出院未發(fā)生DVT。其余實驗組患者以及對照組患者均未出現(xiàn)皮下淤血、黑便、硬膜外血腫、血尿、牙齦出血等出血相關(guān)并發(fā)癥。在出血風(fēng)險方面,兩組進(jìn)行比較無明顯統(tǒng)計學(xué)差異(P0.05)。兩組病例患者術(shù)后隨訪1月,均恢復(fù)良好,未發(fā)現(xiàn)因出血性疾病導(dǎo)致再次住院治療的病例。 結(jié)論在不增加術(shù)后出血的前提下,脊柱手術(shù)后早期即應(yīng)用利伐沙班進(jìn)行抗凝治療能夠明顯降低術(shù)后深靜脈血栓的發(fā)生,尤其是對需要長時間臥床的患者效果更加顯著。
[Abstract]:Objective to investigate the causes and probability of deep venous thrombosis (DVT) in patients with spinal diseases after operation and the safety and efficacy of Levasaban (Rivaroxaban) in preventing deep venous thrombosis (DVT) of lower extremity. Materials and methods from November 2012 to October 2013, 120 adult patients were treated with lumbar spine surgery in the affiliated Hospital of Qingdao University Medical College. There were 76 males and 44 females with an average age of 57.1 years (the youngest 20 years, the maximum 81 years). All the patients were randomly divided into control group and experimental group with 60 cases in each group. Control group: no drug or mechanical anticoagulant was used to prevent deep venous thrombosis. Experimental group: the patients began to take oral anticoagulant therapy (10mg/qd) to prevent deep venous thrombosis from the first day after operation, and stopped taking drugs after 1 week of ground exercise. All the patients in the experimental group and control group had no hematological diseases, and the coagulation mechanism was normal. No previous history of thromboembolic diseases such as cerebral thrombosis, cerebral infarction, no preoperative oral or intravenous use of any anticoagulants. General anesthesia was used in all anesthesia methods. The prothrombin time, hemoglobin D-dimer, platelet, liver function (alanine aminotransferase, alanine aminotransferase) were measured before and after operation. Before and 1 week after operation, both lower extremities were examined by color ultrasound and clinical thromboembolism was observed. To observe the postoperative incision and the occurrence of surgical complications. All patients were followed up for 1 month after discharge. Results there were 117 effective cases in the experimental group and control group, including 58 cases in the control group and 59 cases in the experimental group. In the control group, 7 patients (12. 1%) developed deep vein thrombosis (7 / 58), and 1 case (1 / 58) had symptomatic type. The death rate and mortality were 1.7% (1 / 58) and 10. 4% (6 / 58) respectively in the patients with pulmonary embolism (PE),). There was no pulmonary embolism and death in the experimental group (1 / 59). The results of the above two groups were compared, and the incidence of deep venous thrombosis in the two groups was statistically significant (P0.05). The platelet, fibrinogen, plasma D-dimer and prothrombin time were examined in both groups on the 7th day after operation. The liver function (alanine aminotransferase, alanine aminotransferase) was examined 1 week after operation, and the results between the two groups were analyzed statistically. Two patients in the experimental group had bleeding related complications, one patient had black stool, and one patient had mild congestion under the incision. The symptoms of the two patients were alleviated and disappeared, and no DVT. occurred until discharge from hospital. There were no bleeding related complications such as subcutaneous congestion, black stool, epidural hematoma, hematuria, gingival hemorrhage and so on. In the risk of bleeding, there was no significant difference between the two groups (P0.05). The patients in both groups were followed up for 1 month and recovered well. No rehospitalization due to hemorrhagic disease was found in the two groups. Conclusion the anticoagulant therapy of rivastaban in the early stage of spinal surgery without increasing postoperative bleeding can significantly reduce the incidence of postoperative deep venous thrombosis, especially for patients who need to stay in bed for a long time.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.3

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