| 摘要: |
| 目的:探究乌司他丁联合血塞通对凝血活化因子表达的影响及其在预防髋关节置换术前高凝状态( PTS)及术后下肢深静脉血栓( DVT)形成的效果。方法:选取我院 2016年 4月—2018年 4月收治的 120例行髋关节置换术的患者作为本次研究对象，将其分为观察组和对照组，各 60例。对照组患者术前采用低分子肝素治疗、术后采用血栓通治疗，观察组患者采用乌司他丁联合血塞通进行治疗。比较 DVT发生率，比较两组患者入院时及术前 4 h的活化部分凝血活酶时间(APTT)、血小板计数( PLT)、凝血酶原时间( PT)水平变化。比较麻醉诱导前( Ta)、手术开始后 5 min(Tb)、手术开始后 30 min(Tc)、术后 1 h(Td)患者血浆血栓素 B2(TXB2)、11去氢血栓烷 B(DH-TXB2)、凝血酶敏感蛋白( TSP)、β血小板球蛋白(β -TG)、血小板 α颗粒膜蛋白( GMP-140)水平。比较两组患者入院时、术后即刻、术后 3 d、术后 21 d时血清 CRP、同型半胱氨酸、 D-二聚体水平；比较两组患者治疗前后全血黏度、纤维蛋白原、血细胞比容等指标变化。统计不良反应发生情况。结果:观察组患者术后下肢静脉血栓发生率低于对照组( 13.3% vs. 40.0%，χ2=10.921， P<0.001)。对照组患者术前 4 h PLT水平较入院时降低。术后即刻两组患者 CRP、同型半胱氨酸、 D-二聚体水平均较治疗前升高( P<0.05)。Tc、Td比较，观察组 TXB2、DH-TXB2、TSP均低于对照组。术后 3、21 d天逐渐降低( P<0.05)；治疗前和术后即刻时，两组间 CRP、同型半胱氨酸、D-二聚体差异无统计学意义；术后 3、21d，观察组均低于对照组，差异有统计学意义( P<0.05)。治疗后观察组全血黏度、纤维蛋白原、血细胞比容等均低于对照组( P>0.05)。两组均无严重不良反应发生。结论:采用乌司他丁联合血塞通能够通过降低凝血因子 TXB2、DH-TXB2、TSP水平，降低术后 CRP、同型半胱氨酸、D-二聚体水平，改善血流动力学指标，预防 DVT形成。 |
| 关键词: 下肢静脉血栓 乌司他丁 髋关节置换术 血塞通 低分子肝素 |
| DOI：10.3969/j.issn.1007-6948.2020.01.009 |
| 投稿时间：2018-12-25 |
| 基金项目: |
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| Effect of Rivaroxaban Combined with Xuesaitong on Prevention of PTS and Postoperative Deep Vein Thrombosis Formation after Hip Replacement |
| LU Jun,LIU Hong-liang |
| Xi' an Red Cross Hospital, Xi' an 710054, China |
| Abstract: |
| Objective To investigate the effect of rivaroxaban combined with Xuesaitong in preventing PTS and postoperative deep vein thrombosis (DVT) formation after hip replacement. Methods A total of 120 patients undergoing hip arthroplasty admitted to our hospital from April 2016 to April 2018 were enrolled. The patients were divided into observation group and control group, 60 cases in each group. The patients in the control group were treated with low molecular weight heparin and thrombotherapy before operation. The patients in the observation group received preoperative rivaroxaban and rivaroxaban combined with Xuesaitong. The levels of PLT, APTT and PT were compared between the two groups at the time of admission and 4 h before surgery. The two groups of patients before the induction of anesthesia (Ta), 5 min after the start of surgery (Tb), 30 min after the start of surgery (Tc), 1 h (Td) after surgery were compared, and the levels of plasma thromboxane B2 (TXB2), 11 dehydrogenated thrombus Alkane B (DH-TXB2), thrombin-sensitive protein (TSP), beta-platelet globulin (β-TG), platelet alpha granule membrane protein (GMP-140) in patients with were compared. Serum was compared between the two groups on hospitalized (T0), immediately after surgery (T1), 3 d after surgery (T2), and 21 d after surgery (T3).The levels of CRP, homocysteine and D-dimer were compared. The venous thrombosis of the lower extremities was compared within 3 weeks after operation. The changes of whole blood viscosity, hematocrit and .brinogen before and after treatment were compared between the two groups. The incidence of adverse reactions during the treatment of the two groups of patients was counted. Results The incidence of postoperative lower extremity venous thrombosis was lower in the observation group than that in the control group (13.3% vs 40.0%, χ2=10.921, P<0.0001). In the control group, the PLT level at 4 h before surgery was lower than that at the time of admission. Compared with Tc and Td, the TXB2, DH-TXB2 and TSP in observation groups were lower than the control group, P<0.05. The levels of CRP, homocysteine and D-dimer in the two groups were higher than those before treatment (P<0.05), and gradually decreased after 3 d and 21 d after operation (P<0.05). Compared with the T0 and T1 groups, P>0.05; compared with T2 and T3, the observation group was lower than the control group (P<0.05). After treatment, the whole blood viscosity, hematocrit and .brinogen were lower in the observation group than those in the control group (P>0.05). No serious adverse reactions occurred in either group. Conclusion Ulinastatin combined with Xuesaitong can reduce hemodynamics by reducing the levels of coagulation factors TXB2, DH-TXB2 and TSP, thereby reducing postoperative CRP, homocysteine and D-dimer levels. |
| Key words: Lower extremity venous thrombosis Ustrostatin hip replacement Xuesaitong low molecular weight heparin |
