血栓弹力图评价骨科手术围术期应用利伐沙班与低分子量肝素对凝血功能影响的Meta分析  

Meta-analysis of thromboelastography in evaluating the effects of rivaroxaban and low molecular weight heparin on coagulation during perioperative orthopaedic surgery

作　　者：汪雁博[1] 郝国贞[1] 姜云发[1] 谷新顺[1] WANG Yanbo;HAO Guozhen;JIANG Yunfa;GU Xinshun(The Fifth Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang,Hubei 050000,China)

机构地区：[1]河北医科大学第二医院心血管内五科,河北石家庄050000

出　　处：《检验医学与临床》2022年第S01期57-61,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨血栓弹力图(TEG)评价骨科手术围术期应用利伐沙班与低分子量肝素对凝血功能的影响。方法检索PubMed、迈特思创数据库、中国知网、万方数据库和中国医院数字图书馆,并对文献进行溯源检索。各数据库检索时间为创建至2021年10月。由2名研究人员独立进行文献质量的评价,并提取文献中的相关数据。采用RevMan 5.0软件进行数据管理和统计学分析。结果初检文献122篇,最终入选符合条件的试验10项,共1613例患者。Meta分析结果发现,利伐沙班组治疗7 d后R值大于低分子量肝素组[WMD=0.64,95%CI(0.51,0.76),P<0.05]。利伐沙班组治疗7 d后K值大于低分子量肝素组[WMD=0.17,95%CI(0.07,0.27),P=0.001]。利伐沙班组治疗7 d后α角度小于低分子量肝素组[WMD=-1.78,95%CI(-3.08,-0.48),P=0.007]。利伐沙班组治疗7 d后MA距离小于低分子量肝素组[WMD=-2.26,95%CI(-2.89,-1.63),P<0.05]。利伐沙班组治疗7 d后CI值小于低分子量肝素组[WMD=0.96,95%CI(-1.68,-0.24),P=0.009]。两组患者术后14 d内DVT发生率差异无统计学意义[WMD=0.74,95%CI(0.36,1.49),P=0.39]。结论骨科手术围术期应用利伐沙班的抗凝效果优于低分子量肝素,二者在预防住院期间DVT发生方面效果相当。Objective To explore the effects of rivaroxaban and low molecular weight heparin on coagulation function during the perioperative period of orthopedic surgery evaluated by thromboelastogram(TEG).Methods The databases of PubMed,Metstron database,CNKI,Wanfang database and China Hospital Digital Library were searched from creation to October 2021.The quality of manuscrips was evaluated by two researchers independently,and the data was analyzed.RevMan 5.0 software was used for all statistical analyses.Results A total of 122 manuscripts were initially checked,and 10 eligible trials were finally selected,with a total of 1613 patients.Meta-analysis found that the R value of the rivaroxaban group was higher than that of the LMWH group after 7 days of treatment[WMD=0.64,95%CI(0.51,0.76),P<0.05].The K value of the rivaroxaban group was greater than that of the LMWH group after 7 days of treatment[WMD=0.17,95%CI(0.07,0.27),P=0.001].The angle ofɑin the rivaroxaban group was smaller than that in the LMWH group after 7 days of treatment[WMD=-1.78,95%CI(-3.08,-0.48),P=0.007].The MA distance in the rivaroxaban group was smaller than that in the LMWH group after 7 days of treatment[WMD=-2.26,95%CI(-2.89,-1.63),P<0.05].The CI value of the rivaroxaban group after 7 days of treatment was lower than that of the LMWH group[WMD=0.96,95%CI(-1.68,-0.24),P=0.009].There was no significant difference in the incidence of DVT in the two groups within 14 days after surgery[WMD=0.74,95%CI(0.36,1.49),P=0.39].Conclusion The anticoagulant effect of rivaroxaban during the perioperative period of orthopedic surgery was better than that of LMWH,and the effect on preventing DVT during hospitalization of the above two agents was similar.

关 键 词：利伐沙班 低分子量肝素 凝血功能 血栓弹力图 

分 类 号：R47[医药卫生—护理学]