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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
徐宁,赵怡.利伐沙班在老年全膝关节置换术后预防下肢深静脉血栓的效果[J].中华老年多器官疾病杂志,2020,19(9):686~689
利伐沙班在老年全膝关节置换术后预防下肢深静脉血栓的效果
Rivaroxaban in prevention of deep venous thrombosis in lower limbs after total knee arthroplasty in the elderly
投稿时间:2019-10-22  
DOI:10.11915/j.issn.1671-5403.2020.09.159
中文关键词:  老年人;利伐沙班;全膝关节置换术;下肢静脉血栓;炎症反应
英文关键词:aged; rivaroxaban; total knee arthroplasty; lower limb venous thrombosis; inflammatory response Corresponding author:XU Ning, E-mail:xuning_1@yeah.net〖FL
基金项目:
作者单位E-mail
徐宁 聊城市第二人民医院 关节外科,山东 聊城 252600 xuning_1@yeah.netrivaroxaban 
赵怡 聊城市第二人民医院华美院区综合外科,山东 聊城 252600 xuning_1@yeah.netrivaroxaban 
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中文摘要:
      目的 探讨老年患者行膝关节置换术后应用利伐沙班预防下肢深静脉血栓的有效性及安全性。方法 入选2017年3月至2018年3月初次在我院行全膝关节置换的患者356例,随机分为对照组和观察组,每组178例。对照组给予低分子肝素预防下肢深静脉血栓,观察组给予利伐沙班预防下肢深静脉血栓。比较2组患者术后1年内出现下肢深静脉血栓、出血及死亡的发生情况;同时比较2组患者治疗前后炎症因子(TNF-α、IL-6、IL-1β)和凝血指标(D-Dimer、FIB、APTT、PT、TT、PLT)的变化。采用GraphPad Prism 5.0软件进行数据分析。2组间比较采用t检验或χ2检验,并进行Kaplan-Meier生存分析和Log-rank检验。结果 与治疗前相比,治疗后2组患者的TNF-α、IL-6、IL-1β、PLT、D-Dimer和FIB均明显降低(P<0.05),而APTT、PT和TT明显升高(P<0.05)。治疗后,观察组D-Dimer明显低于对照组(P<0.05)。1年内,观察组下肢深静脉血栓的发生率明显低于对照组(χ2=5.838,P=0.016);观察组和对照组分别有2例(1.12%)和19例(10.67%)患者出现了不良反应,2组间比较差异有统计学意义(χ2=8.865,P=0.003);观察组患者1年生存率明显高于对照组(χ2=4.614,P=0.032)。结论 利伐沙班在老年全膝关节置换术后预防下肢深静脉血栓的效果和安全性优于低分子肝素,其机制可能与抑制炎症反应有关。
英文摘要:
      Objective To investigate the efficacy and safety of rivaroxaban in prevention of lower limb venous thrombosis after total knee arthroplasty in the elderly. Methods A total of 356 patients underging total knee arthroplasty in Liaocheng Second People′s Hospital from March 2017 to March 2018 were randomly divided into the control group and study group (n=178 each). The control group were given low-molecular-weight heparin to prevent venous thrombosis, and the study group were given rivaroxaban to prevent lower limb venous thrombosis. The two groups were compared in the incidence of deep venous thrombosis in the lower limbs, hemorrhage, and death within one year after operation. Changes of inflammatory factors [tumor necrosis factor α(TNF-α), interleukin-6 (IL-6), IL-1β] and coagulation parameters [(D-Dimer, fibrinogen (FIB), activated partial thromboplastin (APTT), prothrombin time (PT), thrombin time (TT), platelet (PLT)] were also compared between two groups before and after treatment. Data analysis was performed using GraphPad Prism 5.0. The t test or χ2 test was used for comparison between the two groups. Survival analysis was estimated by Kaplan-Meier method and Log-rank test. Results Compared with before treatment, TNF-α, IL-6, IL-1β, PLT, D-Dimer and FIB were significantly decreased in the elderly patients after knee arthroplasty (P<0.05), while APTT, PT and TT were significantly increased (P<0.05). The D-Dimer of the study group was significantly lower than that of the control group (P<0.05). After 1 year, the incidence of deep venous thrombosis in the lower limbs was significantly lower in the study group than in the control group (χ2=5.838, P=0.016). Adverse reaction occurred in 2 cases(1.12%) of the study group and 19 cases (10.67%) of the control group with statistically significant difference (χ2=8.865, P=0.003). The 1-year survival rate of the study group was significantly higher than that of the control group (χ2=4.614, P=0.032). Conclusion Rivaroxaban outperformed low-molecular-weight heparin in the efficacy and safety in the prevention of lower limb venous thrombosis after total knee arthroplasty in the elderly, and its mechanism may be related to the inhibition of inflammatory response.
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