脊柱手术后静脉血栓栓塞的2种预防方案比较  

Comparing two prophylaxis methods of venous thromboembolism after spine surgery

作　　者：艾克拜尔.艾拜也都拉 吴彦生[1] 胡炜[1] 黄异飞[1] 

机构地区：[1]新疆医科大学附属中医医院脊柱二科,新疆乌鲁木齐830000

出　　处：《新疆医科大学学报》2010年第10期1257-1259,共3页Journal of Xinjiang Medical University

摘　　要：目的探讨脊柱手术后静脉血栓栓塞(VTE)预防性应用低分子量肝素和利伐沙班的有效性和安全性。方法 2009年8月～2010年2月由同一组术者施行脊柱手术的患者共87例,其中VTE高危者52例、VTE低危者35例。VTE低危组患者术后未予药物预防血栓治疗。VTE高危组患者随机分为2组:第1组(26例)于术后第1天开始应用低分子量肝素抗凝治疗,40mg/次,皮下注射,1次/d,至下地活动后2d停用(共用药3～20d,平均7d);第2组(26例)于术后第1天开始应用利伐沙班(拜瑞妥)抗凝治疗,10mg/次,口服,1次/d,至下地活动后2d停用(共用药3～21d,平均7d),观察第1、2组患者术后VTE的发生率及切口引流量、消化道等粘膜出血情况、硬膜外和伤口血肿情况、有无神经损伤症状。结果第1组患者术后VTE发生率为3.8%(1/26),第2组患者术后VTE发生率为7.6%(2/26),差异无统计学意义(P>0.05);2组患者术后切口引流量的差异无统计学意义(Ρ>0.05),均无粘膜出血、硬膜外及切口血肿,无神经损伤症状。结论脊柱手术后有下肢深静脉血栓形成甚至发生肺栓塞的风险,对有血栓形成危险因素的患者预防性应用利伐沙班或低分子量肝素安全、有效。Objective To discuss the validity and security of low molecular weight heparin（LMWH）and Rinaroxaban Tablets as prophylaxis modality against VTE.Method 87 patients from August 2009 to February 2010 who had undergone spine surgery by the same surgeon group were included in this study.The patients were divided into two groups：VTE high risk group（52 cases）and VTE low risk group（35 cases）.The patients of VTE high risk group divided into two groups randomly.The first group（26 cases）was given LMWH as a prophylaxis modality against VTE;The second group（26 cases）was given Rinaroxaban Tablets as a prophylaxis modality against VTE.The incidences of VTE in both groups were observed,and wound drainage,mucosal hemorrhage,epidural and wound hematomas,and neural injury symptoms of the patients were studied.Results VTE incidence of the first group was 3.8%（1/26）;the second group was 7.6%（2/26）,there was no difference between two groups（Ρ0.05）.In two groups,there was no difference in amount of wound drainage and blood transfusion between VTE high risk and low risk groups（Ρ0.05）.Mucosal hemorrhage,epidural and wound hematomas,neural injury symptoms were not discovered in the second group.Conclusion There is VTE risk in spine surgery.It is effective and safe that the patients undergoing spine surgery have LMWH or Rinaroxaban Tablets as prophylaxis modality against VTE.

关 键 词：脊柱 手术 血栓栓塞 预防 

分 类 号：R61[医药卫生—外科学]