【摘要】 目的:探究膝关节置换术后,阿司匹林、低分子肝素钠、利伐沙班三种抗凝药物对患者下肢深静脉血栓预防效果的差异。方法:选择2017年7月至2019年4月来我院接受膝关节置换术治疗的200例患者作为研究对象,采用随机数字表法将患者分为甲乙丙三组,在膝关节置换术治疗12h后,甲组患者给予口服利伐沙班,乙组给予口服阿司匹林,丙组给予低分子肝素钠注射治疗。观察并对比三组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体数值和血小板值(Plt)等指标,记录下肢深静脉血栓发生率的差异。结果:抗凝后,甲组患者的有效治疗例数(66例)明显高于乙组(44例,68.75%)、丙组(47例,71.21%),总有效治疗率为94.29%,三者差异显著(P<0.05);甲乙丙三组的PT、APTT、Plt指标两两比较,甲乙组、乙丙组的三项指标无明显差异(P>0.05),甲丙组的三项指标差异明显(P<0.05);治疗后1d、1周、15d后,甲组D-二聚体数值明显低于丙组(P<0.05);治疗后1周、15d后,甲组D-二聚体数值明显低于乙组(P<0.05);术后甲组患者出现2例DVT,发生率为5.88%;乙组出现6例,发生率17.65%;丙组出现10例,发生率29.4%。甲乙(χ~2=2.267,P=0.132)与乙丙(DVTχ~2=1.308,P=0.253,)两两相比,无明显差异;甲丙(DVT发生率,χ~2=6.476)两组相比,二者差异显著(P <0.05)。结论:与低分子肝素相比,阿司匹林的疗安全性能更高,但对治疗效果的提高作用更低;利伐沙班的抗凝效果更高,但隐性失血量及切口并发症发生率较高。因此,可根据患者实际情况的抗凝需求合理选择。更多还原

【Abstract】 Objective: To investigate the preventive effect of aspirin,low molecular weight heparin sodium and rivashaban on deep venous thrombosis of lower extremity after knee arthroplasty. Methods: 200 patients with total knee replacement in our hospital from July 2017 to April 2019 were selected as the subject of the study.The patients with the group A were given an oral rivasahan treatment,and the povtients in group B was given an oral aspirin,and the group C was given low molecular heparin sodium injection treatment. The prothrombin time( PT),activated partial thromboplastin time( APTT),D-dimer) and platelet value( Plt)were observed and compared among the three groups,and the incidence of deep venous thrombosis of lower extremity was recorded. Results: After anticoagulation,the number of effective treatment cases in group A( 66 cases) was significantly higher than that in group B( 44 cases,68.75%) and group C( 47 cases,71.21%).The total effective treatment rate was 94.29%,with a significant difference( P <0.05); There was no significant difference in Pt,APTT and PLT indexes between group A and group B( P >0.05),and there was significant difference in three indexes between group A and group C( P <0.05); One day,one week and 15 days after the treatment,the D-dimer value of group A was significantly lower than that of group B( P <0.05); one week and 15 days after the treatment,the D-dimer value of group A was significantly lower than that of group C( P <0.05); two patients in group A had DVT,the incidence was 5.88%; six patients in group B,the incidence was 17.65%; ten patients in group C,the incidence was 29.4%. There was no significant difference between the two groups( χ~2= 2.267,P = 0.132) and the two groups( DVT χ~2= 1.308,P = 0.253,P = 0.253,P <0.05). Conclusion: Compared with low molecular weight heparin,aspirin has a higher therapeutic safety,but a lower therapeutic effect; rivaroxaban has a higher anticoagulant effect,but a higher incidence of occult blood loss and incision complications. Therefore,the anticoagulation needs of patients can be reasonably selected according to the actual situation.更多还原