磺达肝癸钠在骨科大手术围术期抗纤溶药序贯抗凝治疗中的临床研究  

Clinical study of fondaparinux in perioperative antifibrinolytic sequential anticoagulation therapy in major orthopedic surgery

作　　者：黄歆[1] 徐磊 谢威 杨浩森[1] 熊德建 胡彦婷 汪瑜[2] HUANG Xin;XU Lei;XIE Wei;YANG Haosen;XIONG Dejian;HU Yanting;WANG Yu(Department of Orthopedics,Chengdu Seventh People's Hospital,Chengdu 610213,China;Department of Scientific Research Teaching,Chengdu Seventh People's Hospital,Chengdu 610213,China)

机构地区：[1]成都市第七人民医院骨科,成都610213 [2]成都市第七人民医院科研教学部,成都610213

出　　处：《中国临床药学杂志》2024年第10期769-773,共5页Chinese Journal of Clinical Pharmacy

基　　金：四川省医学会静脉血栓栓塞症防治(恒瑞)专项科研课题(编号2019HR23)。

摘　　要：目的探讨磺达肝癸钠在骨科大手术围术期抗纤溶药序贯抗凝治疗中的有效性及安全性。方法将2020年1月至2021年12月收治的拟行骨科大手术治疗的患者89例随机分为对照组(n=44)和试验组(n=45)。2组患者均采用抗纤溶药(氨甲环酸)序贯抗凝治疗(对照组予依诺肝素钠,试验组予磺达肝癸钠)。观察2组患者静脉血栓栓塞发生率、死亡率、总失血量、血红蛋白、血小板计数、凝血功能变化趋势和大出血事件发生率。结果对照组和试验组的总失血量分别为(269.34±240.79)mL和(231.84±119.77)mL(P>0.05)。2组的血红蛋白和血小板计数在术前和术后第1、2、3、7、14天差异均无统计学意义(P>0.05)。术后第3天,试验组的凝血酶原时间显著长于对照组(P<0.05);术后第7天,试验组的部分活化凝血酶原时间显著长于对照组(P<0.05)。2组均未发生下肢深静脉血栓和肺血栓栓塞症。结论骨科大手术围术期将磺达肝癸钠应用于抗纤溶药序贯抗凝治疗是安全有效的,值得推荐。AIM To investigate the efficacy and safety of fondaparinux in perioperative anticoagulation therapy in patients undergoing major orthopedic surgery.METHODS From January 2020 to December 2021,89 patients who underwent major orthopedic surgery were randomly divided into control group(n=44)and experiment group(n=45).Patients in both groups received antifibrinolytic medication(tranexamic acid)followed by sequential anticoagulant therapy(the control group was given enoxaparin,while the experiment group was given fondaparinux).The incidence of venous thromboembolism(VTE),mortality,total blood loss,changes in hemoglobin(Hb),platelet count(PLT),coagulation function,and incidence of major bleeding events were observed.RESULTS The total blood loss between the control group and experiment group was(269.34±240.79)mL and(231.84±119.77)mL,respectively.There were no statistically significant differences in Hb and PLT in the control group and experiment group on preoperative and postoperative days 1,2,3,7,and 14(P>0.05).The prothrombin time(PT)of experiment group was significantly longer than that of control group at 3 days after operation(P<0.05).At 7 days after surgery,the activated partial thromboplastin time(APTT)of experiment group was significantly longer than that of control group(P<0.05).Neither group experienced deep vein thrombosis or pulmonary thromboembolism.CONCLUSION It is safe and effective to apply fondaparinux to sequential anticoagulant therapy of antifibrinolytic agents during perioperative period of major orthopedic surgery,which is worthy of recommendation.

关 键 词：深静脉血栓 抗凝 序贯疗法 依诺肝素钠 磺达肝癸钠 

分 类 号：R969.3[医药卫生—药理学]