髋关节置换后药物预防深静脉血栓的分组对照

背景:术后深静脉血栓形成是髋关节置换患者围手术期的危险并发症之一,药物治疗是预防血栓形成的有效方法,临床上正逐步规范用药方案,以取得最佳的预防效果。目的:探索置换后预防血栓的规范化治疗措施。方法:回顾分析固原市人民医院骨科2010-01/2011-05接受髋关节置换者110例,应用低分子肝素、磺达肝癸钠、利伐沙班及华法林防治深静脉血栓的临床资料,用药方案根据《中国骨科大手术静脉血栓栓塞症预防指南(2009版)》的要求。将上述临床结果与2007-01/2009-12接受骨科髋关节置换后不规律用药者123例的临床资料比较分析。结果与结论:所有患者均无因注射抗凝药物而产生明显不适症状。两组中均有少量病例在置换后出现不同深静脉血栓临床症状。不规律用药组和规律用药组D-二聚体检测分别有45,29例阳性。不规律用药组与规律用药组的深静脉血栓主要发生在置换后4周内,随着置换后用药时间的延长,血栓发生率出现下降趋势。置换后12周时规律用药组发生血栓人数明显低于不规律用药组(P<0.05)。提示在髋关节置换后规律应用低分子肝素、磺达肝癸钠、利伐沙班及华法林可有效预防深静脉血栓的发生。

Prevention and medical treatment of deep vein thrombosis after hip replacement: A controlled trial

BACKGROUND: Deep vein thrombosis (DVT) after hip replacement operation is one of risk complications. Drug therapy is an effective way to prevent thrombosis. To achieve the best preventive effect, standardized medication program is used in clinical. OBJECTIVE: To summarize the prevention and treatment experience of DVT in patients after hip replacement operation. METHODS: Totally 110 patients who received hip replacement from Department of Orthopedics, Guyuan City People’s Hospital between January 2010 and May 2011 were analyzed retrospectively. Clinical data of the patients who received low molecular weight heparin, Fondaparinux sodium, Rivaroxaban and warfarin for prevention of DVT were selected according to the requirement of China Orthopedic Surgery Venous Thromboembolism Prevention Guideline (2009 edition). Above-mentioned clinical results were compared with the clinical data from 123 patients who were also received hip replacement but were treated with drug irregularly to prevent DVT postoperatively between January 2007 and December 2009. RESULTS AND CONCLUSION: All the patients had no obviously uncomfortable symptoms after anticoagulant injection. Few patients with DVT in the both groups were found. D-dimer detection of 45 and 29 cases in the irregular group and the regular group were positive respectively. DVT of the two groups occurred at 4 weeks after hip replacement. Incidence of thrombosis was decreasing with the medication time. Patients with thrombosis in the regular group were obviously lower than those in the irregular group at 12 weeks after hip replacement (P < 0.05). It is indicated that to regularly use low molecular weight heparin, Fondaparinux sodium, Rivaroxaban and warfarin can efficiently prevent the occurrence of DVT after hip replacement.