利伐沙班与低分子肝素钠预防肝胆外科腹腔镜手术后深静脉血栓形成的临床研究  

A clinical study on prevention of lower extremity deep vein thrombosis by low-molecularweight-heparin and rivaroxaban in patients after hepatobiliary laparoscopic surgery

作　　者：邓天芝[1] 龙洪航[1] 陈晓梅[1] 张瑞燕[2] DENG Tian zhi;LONG Hong hang;CHEN Xiao mei;ZHANG Rui yan(Department of Hepatobiliary Surgery,The First Affiliated Hospital,Chengdu Medical College,Chengdu 610500,China;The Second District of General Surgery,Xiaolan People s Hospital of Zhongshan City,Zhongshan 528415,China)

机构地区：[1]成都医学院第一附属医院肝胆外科,四川成都610500 [2]广东省中山市小榄人民医院普外二区,广东中山528415

出　　处：《实用医院临床杂志》2019年第6期160-163,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨比较利伐沙班和低分子肝素预防肝胆外科腹腔镜手术后下肢深静脉血栓(DVT)形成中的作用。方法选择2014年1月至2017年2月在我院因肝胆外科疾病接受腹腔镜择期手术的患者118例。按照随机数字表法分为对照组(低分子肝素组)和研究组(利伐他班组)各59例。对照组患者皮下注射低分子肝素钙注射液100 U,qd;研究组患者口服利伐沙班片10 mg,qd。两组患者均从术后第1天开始治疗,连续用药7天。观察两组患者治疗前后凝血功能指标:活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶原时间(PT)、D 二聚体(D dimer)及术后DVT发生率,比较两组患者术后出血事件等不良反应发生情况。结果低分子肝素组DVT的发生率3.4%(2/59),利伐沙班组发生率仅为1.7%(1/59),两组患者DVT发生率比较差异无统计学意义。两组患者治疗前后PLT计数、APTT时间、PT时间、FIB,血浆D 二聚体比较,差异无统计学意义(P>0.05)。两组患者均未发生严重出血事件。结论利伐沙班与低分子肝素钙均能够预防肝胆外科腹腔镜手术后DVT的形成;且不会增加不良反应,特别是出血事件的发生风险。Objective To compare the clinical efficacy and safety between rivaroxaban and low molecular weight heparin cal cium(LMWHA)in the prevention of deep venous thrombosis(DVT)in patients after hepatobiliary laparoscopic surgery.Methods A total of 118 patients undergone hepatobiliary laparoscopic surgery in our hospitals from January 2014 to February 2017 were randomly divided into control group(LMWH group)and experiment group(rivaroxaban group),59 in each group.The control group was given heparin calcium injection 100 IU subcutaneously,qd while the experiment group was given rivaroxaban tablet 10 mg,qd.The treatment in both groups were started on the first day after operation and continued for 7 days.The outcome measured by D dimer,PT,APTT,FIB and platelet counts and occurrence of DVT in both groups.Postoperative bleeding events and other adverse reaction were compared between the two groups.Results The incidence of DVT in the LMWH group was 3.4%(2/59)while it was 1.7%(1/59)in the rivar oxaban group(P>0.05).There was no statistical significance in D dimer,PT,APTT,FIB and platelet counts before and after surgery between the two groups(P>0.05).No postoperative bleeding events were found in both groups.Conclusion LMWH and rivaroxaban both can be used to reduce incidence DVT in patients after hepatobiliary laparoscopic surgery and have similar therapeutic efficacy and safety.

关 键 词：下肢深静脉血栓 腹腔镜手术 利伐他班 低分子肝素 

分 类 号：R65[医药卫生—外科学]