低分子肝素序贯阿司匹林对单侧髋或膝关节置换术后患者的治疗效果及下肢深静脉血栓形成的影响  

Influence of sequential therapy with low molecular weight heparin and aspirin on treatment effect and lower limb DVT in patients after hip or knee replacement

作　　者：杨宇轩 陈佳伟 刘拴[1] 谭伟[2] Yang Yuxuan;Chen Jiawei;Liu Shuan;Tan Wei(Department of Joint Orthopedics,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan430064,Hubei,China;Department of Medical Imaging,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan430064,Hubei,China)

机构地区：[1]武汉科技大学附属天佑医院关节骨科,湖北武汉430064 [2]武汉科技大学附属天佑医院影像医学科,湖北武汉430064

出　　处：《血管与腔内血管外科杂志》2022年第2期241-245,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨低分子肝素序贯阿司匹林治疗对单侧髋或膝关节置换术后患者凝血功能、下肢静脉血流动力学及深静脉血栓形成(DVT)的影响。方法 收集2019年6月至2021年6月武汉科技大学附属天佑医院收治的116例单侧髋或膝关节置换术后患者的临床资料。根据抗凝治疗方式的不同将患者分为观察组(皮下注射低分子肝素序贯阿司匹林口服治疗)和对照组(皮下注射低分子肝素),每组58例。比较两组患者用药前、用药后10 d、用药后5周的凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)]、下肢静脉血流动力学指标(平均血流速度、血流峰流速、平均血流量)。观察并比较两组患者术后5周内下肢DVT发生率和治疗期间不良反应发生情况。结果 用药后10 d、5周,两组患者的APTT、PT均较用药前延长,D-D水平均较用药前下降(P<0.05);用药后5周,观察组患者的APTT、PT均较用药后10 d延长,D-D水平较用药后10 d下降,且观察组患者的APTT、PT均长于对照组患者(P<0.05)。用药后10 d、5周,两组患者的平均血流速度、血流峰速度、平均血流量均较用药前升高(P<0.05);用药后5周,观察组患者的血流峰速度较用药后10 d升高,且高于对照组患者(P<0.05)。用药后5周内,观察组患者下肢DVT的发生率为1.72%(1/58),低于对照组患者的13.79%(8/58)(P=0.037)。用药期间,两组患者的不良反应总发生率比较,差异无统计学意义(P=0.542)。结论 相较于单纯低分子肝素治疗,单侧髋或膝关节置换术后患者采用低分子肝素和阿司匹林序贯治疗,有助于改善凝血功能、下肢静脉血流动力学,降低DVT发生率,且不增加不良反应。Objective To observe the influence of sequential therapy with low molecular weight heparin and aspirin on postoperative coagulation function, lower limb venous hemodynamics and formation of deep venous thrombosis(DVT) in patients after unilateral hip or knee replacement. Method The clinical data of 116 patients undergoing unilateral hip or knee replacement in Tianyou Hospital Affiliated to Wuhan University of Science and Technology were collected between June 2019 and June 2021. According to the different anticoagulant treatment methods, the patients were divided into observation group(subcutaneous injection of low molecular weight heparin and oral administration of aspirin) and control group(subcutaneous injection of low molecular weight heparin), with 58 cases in each group. The coagulation function indicators [activated partial thromboplastin time(APTT), prothrombin time(PT), D-dimer(D-D)] and lower limb venous hemodynamic indicators(mean blood flow velocity, peak flow velocity, mean blood flow) of the two groups were compared before medication and at 10 days and 5 weeks after medication, and the incidence rate of lower limb DVT within 5 weeks after surgery and occurrence of adverse reactions during treatment were observed and compared between the two groups. Result At 10 days and 5 weeks after medication, the APTT and PT of the two groups were longer than those before medication, and D-D value was lower than that before medication(P<0.05). The APTT and PT in the observation group were longer at 5 weeks after medication than those at 10 days after medication, and the D-D value was lower than that that at 10 days after medication, and APTT and PT of the observation group were longer than those of the control group(P<0.05). At 10 days and 5 weeks after medication, the mean blood flow velocity, peak flow velocity and mean blood flow of the two groups of patients were higher than those before medication(P<0.05). At 5 weeks after medication, the peak flow velocity in observation group was higher than that at 10 day

关 键 词：关节置换术 下肢 深静脉血栓形成 预防 低分子肝素 阿司匹林 

分 类 号：R543[医药卫生—心血管疾病]