氨甲环酸与利伐沙班联合应用对膝关节置换术中减少出血及预防静脉血栓的临床研究  

Tranexamic acid combined with rivaroxaban in reducing bleeding and prevention of venous thrombosis in knee arthroplasty

作　　者：邢国宽[1] 刘喜凤[1] 苑佳琦 陈光[1] 

机构地区：[1]河北省廊坊市人民医院骨科,河北廊坊065000

出　　处：《实用药物与临床》2016年第3期326-330,共5页Practical Pharmacy and Clinical Remedies

基　　金：廊坊市科学技术研究与发展计划项目(201401-3130)

摘　　要：目的探讨氨甲环酸与利伐沙班对单侧全膝关节置换后患者减少出血及预防静脉血栓的临床效果。方法随机入选符合条件的行初次单侧全膝关节置换的120例患者随机分为氨甲环酸+利伐沙班组(实验组)与对照组,测量、记录、分析两组患者的失血量和输血量、血红蛋白、红细胞压积、凝血指标、出血事件的发生率及下肢静脉血栓的发生情况。结果实验组的总失血量、隐性出血量、输血量、输血率低于对照组,差异有统计学意义(P<0.05);手术后,实验组的血红蛋白(Hb)、红细胞压积(HCT)、膝关节HSS评分均明显优于对照组,差异有统计学意义(P<0.05);手术前后,实验组和对照组的纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间比较差异无统计学意义(P>0.05);两组患者的临床相关非大出血事件发生率比较差异无统计学意义(P>0.05)。结论氨甲环酸与利伐沙班联合应用于初次单侧全膝关节置换术中,可有效减少出血量,同时不影响患者全身的凝血系统,对预防下肢静脉栓塞具有良好的效果,值得在临床推广使用。Objective To investigate the effect of tranexamic acid combined with rivaroxaban in reducing bleeding and prevention of venous thrombosis in knee arthroplasty. Methods Totally 120 patients receiving primary unilateral total knee replacement were randomly selected and divided into tranexamic acid ＋ rivaroxaban group（ treatment group） and control group. Blood loss and blood transfusion,hemoglobin hematocrit,incidence of coagulation,incidence of bleeding events and deep vein thrombosis of the two groups of patients were measured,recorded and analyzed.Results The total blood loss,invisible bleeding and blood transfusion in the experimental group were significantly lower than those of control group,the differences being significant（ P〈0. 05）; after surgery,Hb,HCT and HSS scoresin the experimental group were significantly better than those of the control group（ P〈0. 05）; before and after surgery,fibrinogen,prothrombin time and activated partial thromboplastic time of the experimental group and control group were not statistically difference（ P〉0. 05）; clinically relevant non-major bleeding event rate of the two groups showed no significant difference（ χ^2= 0. 139,P = 0. 709）. Conclusion Combined use of tranexamic acid and rivaroxaban in the primary unilateral total knee replacement surgery can effectively reduce the amount of bleeding without affecting the body＇s clotting system and prevent deep vein thrombosis,so it is worthy of clinical application.

关 键 词：氨甲环酸 利伐沙班 膝关节置换术 静脉血栓 

分 类 号：R687.4[医药卫生—骨科学]