低分子肝素与利伐沙班预防脊柱外科手术后下肢深静脉血栓的疗效和安全性比较  

Comparison of the Efficacy and Safety of Low Molecular Weight Heparin and Rivaroxabanon in the Prevention of Deep Venous Thrombosis after Spinal Surgery

作　　者：侯训凯 林永杰[1] 石恩东[1] 王炳臣 王国伟[1] 孙庆山[1] 王鹏[1] 

机构地区：[1]山东省交通医院,济南250031

出　　处：《中国药房》2015年第30期4221-4223,共3页China Pharmacy

摘　　要：目的:比较低分子肝素与利伐沙班预防脊柱外科手术后下肢深静脉血栓的疗效和安全性。方法:276例有高危因素的脊柱外科手术后患者随机均分为对照组和观察组。两组患者均于术后第1天至3个月予以弹力袜物理预防下肢深静脉血栓形成。在此基础上,对照组患者于术后第1天开始给予低分子肝素钙注射液1支,皮下注射,每日1次;观察组患者于术后第1天开始给予利伐沙班片1片,口服,每晚1次。两组患者均治疗2周后评价疗效,观察治疗前后股浅静脉内径(FSV)、腘静脉内径(POPV)、凝血酶原时间(PT)、纤维蛋白原降解产物(FIB)、D-二聚体(D-D)和下肢深静脉血栓发生率及不良反应发生情况。结果:两组患者总有效率、下肢深静脉血栓发生率、不良反应发生率比较,差异均无统计学意义(P>0.05)。治疗3个月后,观察组患者FSV、POPV与治疗前比较,差异均无统计学意义(P>0.05),而对照组患者POPV显著低于同组治疗前及观察组,差异均有统计学意义(P<0.05);治疗1周后,两组患者PT与同组治疗前比较差异均无统计学意义(P>0.05),而FIB、D-D显著高于同组治疗前,差异均有统计学意义(P<0.05),但两组间比较差异均无统计学意义(P>0.05);治疗4周后,两组患者PT均显著高于同组治疗前,差异均有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05),而FIB、D-D仍均显著高于同组治疗前,但观察组低于对照组,差异均有统计学意义(P<0.05)。结论:低分子肝素与利伐沙班预防脊柱外科手术后下肢深静脉血栓的疗效和安全性均较好,但利伐沙班在改善凝血功能方面优于低分子肝素。OBJECTIVE： To compare the efficacy and safety of low molecular weight heparin and rivaroxaban in the preven- tion of deep venous thrombosis after spinal surgery. METHODS： Totally 276 patients with high risk factors after spinal surgery were randomly divided into control group and observation group. The patients in the two groups were used elastic stockings to physi- cally prevent deep venous thrombosis from the postoperative first day to continue 3 months; based on it, control group was subcuta- neously injected with 1 low molecular weight heparin from the postoperative first day, once a day. Observation group was orally treated with 1 Rivaroxaban tablet, once every night. The treatment course for 2 groups was 2 weeks. The clinic data was observed, including clinical efficacy, superficial femoral vein diameter （FSV）, popliteal vein diameter （POPV）, prothrombin time （PT）, fi- brinogen degradation products （FIB） and D- dimer （DD） before and after treatment, incidence of deep venous thrombosis and ad- verse reactions. RESULTS： There were no significant differences in the total effective rate and deep venous thrombosis and inci- dence of ADR between 2 groups （P〉0.05）. After 3 months, compared with before, there were no significant differences in the FSV and POPV between 2 groups （P〉0.05） ; POPV in control group was significantly lower than before and observation group, there was statistical significance （P〈0.05）. After 1 week, compared with before, there was no significant difference in the PT be- tween 2 groups （P〉0.05） ; the FIB and D-D were significantly higher than before, there was statistical significance（P〈0.05）, however, there were no significant differences between 2 groups （P〉0.05） ; after 4 weeks, PT in 2 groups was significantly high- er than before, there was statistical significance （P〈0.05）, however, there were no significant differences between 2 groups（P〉 0.05） ; FIB and D-D were significantly higher than before, and observatio

关 键 词：脊柱外科手术 下肢深静脉血栓 利伐沙班 低分子肝素 疗效 安全性 

分 类 号：R453.9[医药卫生—治疗学]