下肢血液循环泵联合利伐沙班预防下肢关节置换术后静脉血栓形成临床研究

目的观察并探讨下肢血液循环泵联合利伐沙班预防下肢关节置换术后静脉血栓形成的临床效果。方法选取关节科2012年7月至2014年1月收治的行全髋（膝）关节置换术患者70例,按随机数字表法分为观察组（37例）和对照组（33例）。对照组术后予基础护理＋利伐沙班抗凝处理,观察组在对照组基础上加用下肢血液循环泵,每日2次,连续使用10-14 d,对比两组术后2,7 d凝血功能、下肢周径,并观察深静脉血栓（DVT）发生率。结果观察组术后2 d凝血活酶时间（APTT）[（34.3±5.8）s比（30.2±4.6）s],术后7 d凝血酶原时间（PT）[（15.9±3.5）s比（14.3±3.1）s]、APTT[（36.8±5.3）s比（34.3±4.9）s]均长于对照组（t1=3.250,t2=2.014,t3=2.041,P〈0.05）;术后2 d观察组与对照组大腿周径[（47.5±4.1）cm比（49.6±4.5）cm],小腿周径[（37.2±2.9）cm比（38.7±3.3）cm];术后7 d两组大腿周径[（46.2±4.0）cm比（48.2±3.8）cm]、小腿周径[（36.2±2.7）cm比（37.6±2.5）cm],差异均有统计学意义（t1=2.043,t2=2.024,t3=2.138,t4=2.242,P〈0.05）。观察组术后下肢DVT发生率8.11%（3/37）明显低于对照组水平27.27%（9/33,χ2=4.510,P=0.034）。结论血液循环泵能通过改善下肢血流,增加纤溶活性,发挥抗凝作用,联合利伐沙班可有效预防下肢关节置换术后下肢DVT的发生。

Clinical Study on Lower Limb Blood Circulation Pump Combined with Rivaroxaban in Preventing Venous Thrombosis after Lower Limb Arthroplasty

Objective To explore the clinical efficacy of the lower limb blood circulation pump combined with rivaroxaban in preventing deep venous thrombosis（ DVT） after lower limb arthroplasty. Methods 70 cases of total hip（ knee） replacement（ THR / TKR） in our department from July 2012 to January 2014 were selected as the study subjects and randomly divided into the observation group（ 37cases） and the control group（ 33 cases） according to the random numbers. The control group was given the basic nursing and rivaroxaban for conducting the anticoagulation treatment after THR or TKR surgery, while on this basis the observation group was added with the lower limb blood circulation pump,twice a day for continuous 10- 14 d. The coagulation function and the lower limb circumference on postoperative 2,7 d were compared between the two groups and the occurrence rate of DVT in 2 groups was also observed. Results The activated partial thromboplastin time（ APTT） on postoperative 2 d in the observation group was longer than that in the control group [（ 34. 3 ± 5. 8） s vs.（ 30. 2 ± 4. 6） s ]; the same differences on postoperative 7 d also were seen in the prothrombin time（ PT）[（ 15. 9 ± 3. 5） s vs.（ 14. 3 ± 3. 1） s ] and APTT [（ 36. 8 ± 5. 3） s vs.（ 34. 3 ± 4. 9） s ], the differences were all statistically significant（ t1 =3. 250,t2= 2. 014,t3= 2. 041, P〈0. 05）. The thigh circumference on postoperative 2 d in the observation group and the control group was（ 47. 5 ± 4. 1） cm vs.（ 49. 6 ± 4. 5） cm, the calf circumference was（ 37. 2 ± 2. 9） cm vs.（ 38. 7 ± 3. 3） cm, which on postoperative 7 d were（ 46. 2 ± 4） cm vs.（ 48. 2 ± 3. 8） cm and（ 36. 2 ± 2. 7） cm vs.（ 37. 6 ± 2. 5） cm, all the lower limb circumference indexes after operation had statistically significant differences（ t1 = 2. 043, t2 = 2. 024, t3 = 2. 138, t4 = 2. 242, P〈0. 05）. The occurrence rate of postoperative lower limb DVT in the observation group was 8. 11%（ 3 /