小剂量低分子肝素钙联合利伐沙班对高龄骨折患者围术期缺血卒中的预防作用  

Preventive Effect of Low-dose Low-molecular-weight Heparin Calcium Combined with Rivalsaban on Perioperative Ischemic Stroke in Elderly Patients with Fracture

作　　者：赵旭 ZHAO Xu(Liaoning Haicheng central hospital,Haicheng,Liaoning 114200)

机构地区：[1]辽宁省海城市中心医院,辽宁海城114200

出　　处：《中国伤残医学》2023年第20期31-35,共5页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探究低分子肝素钙联合利伐沙班用于高龄骨折患者预防围术期缺血卒中的作用。方法:选取我院2019年5月-2021年5月收治的80例高龄骨折患者按随机数字表法分组,各40例。所有患者均行内固定术治疗,对照组给予低分子肝素钙治疗,观察组给予低分子肝素钙联合利伐沙班治疗,对比2组围术期缺血卒中发生情况、DVT发生率及治疗前后凝血功能(APTT、PT、TT及FIB水平)、血清学指标(D-D、MMP-9、NT-proBNP及sVCAM-1)及血液流变学指标(RBV高切、RBV中切及RBV低切)。结果:缺血卒中发生率比较差异无统计学意义(P>0.05);治疗后7天、15天DVT发生率比较,观察组分别为2.50%、5.00%,均低于对照组的20.00%、27.50%,差异有统计学意义(P<0.05);观察组治疗后APTT、PT及TT水平较对照组更高,FIB水平较对照组更低(P<0.05);观察组治疗后D-D、MMP-9、NT-proBNP及sVCAM-1水平较对照组更低(P<0.05);观察组治疗后RBV高切、RBV中切及RBV低切水平较对照组更低(P<0.05)。结论:高龄骨折患者应用小剂量低分子肝素钙联合利伐沙班治疗,可有效预防围术期缺血卒中发生,改善患者凝血功能,下调炎性因子表达,促进血液流变学改善,并减少DVT发生。Objective:To investigate the effect of low-molecular-weight heparin calcium combined with rivalsaban in preventing perioperative ischemic stroke in elderly fracture patients.Methods:80 elderly patients with fracture were randomly divided into 40 cases each.All patients were treated with internal fixation.The control group was treated with low-molecular-weight heparin calcium,and the observation group was treated with low-molecular-weight heparin calcium combined with rivalsaban.The incidence of perioperative ischemic stroke,DVT incidence,coagulation function(APTT,PT,TT and FIB levels),serological indicators(D-D,MMP-9,NT proBNP and sVCAM-1),and hemorheological indicators(RBV high cut,RBV middle cut,and RBV low cut)were compared between the two groups.Results:There was no significant difference in the incidence of ischemic stroke(P>0.05);Compared with the inci-dence of DVT 7 days and 15 days after treatment,2.50%and 5.00%in the observation group were lower than 20.00%and 27.50%in the control group,with a statistically significant difference(P<0.05);After treatment,the levels of APTT,PT and TT in the observa-tion group were higher than those in the control group,while the levels of FIB in the observation group were lower than those in the control group(P<0.05);After treatment,the levels of D-D,MMP-9,NT proBNP and sVCAM-1 in the observation group were lower than those in the control group(P<0.05);After treatment,the levels of RBV high cut,RBV middle cut and RBV low cut in the observation group were lower than those in the control group(P<0.05).Conclusion:Low dose low-molecular-weight heparin calcium combined with rivalsaban can effectively prevent perioperative ischemic stroke,improve blood coagulation,reduce the expression of inflammatory factors,promote the improvement of hemorheology,and reduce the occurrence of DVT in elderly patients with fracture.

关 键 词：小剂量低分子肝素钙 利伐沙班 高龄骨折 围术期 缺血卒中 

分 类 号：R683[医药卫生—骨科学]