【摘要】：目的探討低分子肝素鈣、利伐沙班和阿哌沙班對初次人工全膝關(guān)節(jié)置換術(shù)圍手術(shù)期抗凝治療的療效及其并發(fā)癥。方法2014年4月—9月,行初次人工全膝關(guān)節(jié)置換術(shù)的60例膝關(guān)節(jié)骨性關(guān)節(jié)炎的患者,進(jìn)行隨機(jī)分組,即低分子肝素鈣組、利伐沙班組和阿哌沙班組,每組20例。根據(jù)圍手術(shù)期紅細(xì)胞比容計算隱性失血量;監(jiān)測三組患者術(shù)前和術(shù)后1天、3天、5天,血常規(guī)和術(shù)側(cè)髕上10cm及髕下10cm肢體周徑變化。分析三組藥物對患者圍手術(shù)期隱性失血、大出血事件、非嚴(yán)重出血、輸血需求、凝血功能的變化、肝腎功能的變化、術(shù)后切口感染、深靜脈血栓形成、肺栓塞等的影響。結(jié)果三組術(shù)后隱性失血量分別為937.4±308.7ml、887.8±311.4ml、889.8±296.9ml,無顯著性差異,P0.05。三組中的無血栓組,隱性失血與術(shù)側(cè)下肢髕上及髕下肢體周徑變化有相關(guān)性,具有統(tǒng)計學(xué)意義,P0.05。三組術(shù)側(cè)下肢髕上肢體周徑變化值存在差異,具有統(tǒng)計學(xué)意義,P0.05。三組深靜脈血栓形成、肺栓塞等并發(fā)癥的發(fā)生率無顯著性差異,P0.05。結(jié)論接受初次全膝關(guān)節(jié)置換術(shù)的患者,分別應(yīng)用低分子肝素鈣、利伐沙班和阿哌沙班預(yù)防性抗凝,都能夠有效預(yù)防VTE的發(fā)生,且對術(shù)后并發(fā)癥的影響無明顯差異,其有效性和安全性相當(dāng)。但低分子肝素鈣相對于利伐沙班、阿哌沙班會增加術(shù)側(cè)下肢肢體腫脹程度。
[Abstract]:Objective to evaluate the efficacy and complications of low molecular weight heparin calcium (LMWH), rivastabine and piperazabine in the perioperative treatment of primary total knee arthroplasty. Methods from April to September, 2014, 60 patients with osteoarthritis of knee joint underwent the first total knee arthroplasty. They were randomly divided into three groups: low molecular weight heparin calcium group, rivastaban group and piperzapan group, 20 cases in each group. The recessive blood loss was calculated according to the specific volume of erythrocyte in perioperative period, and the changes of blood routine and limb circumference of suprapatellar 10cm and subpatellar 10cm were monitored before and 1 day after operation. The effects of three groups of drugs on recessive hemorrhage, massive hemorrhage, non-severe hemorrhage, blood transfusion demand, changes of coagulation function, changes of liver and kidney function, postoperative wound infection, deep vein thrombosis and pulmonary embolism were analyzed in three groups. Results the occult blood loss in the three groups was 937.4 鹵308.7 ml, 887.8 鹵311.4 ml, 889.8 鹵296.9 ml, respectively (P 0.05). The recessive blood loss was correlated with the changes of peripatellar diameter of the upper patellar and subpatellar limbs in the three groups with statistical significance (P0.05). There was significant difference in peripatellar diameter between the three groups (P 0.05). There was no significant difference in the incidence of complications such as deep venous thrombosis and pulmonary embolism among the three groups (P 0.05). Conclusion low molecular weight heparin calcium, rivastabine and piperazabine can effectively prevent the occurrence of VTE in patients undergoing primary total knee arthroplasty, and there is no significant difference in postoperative complications. Its effectiveness and safety are equal. Low molecular weight heparin calcium (LMWH), compared with rivasaban, increased the swelling of the lower extremity of the operative side.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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