利伐沙班与低分子肝素对老年糖尿病患者全髋关节置换术后深静脉血栓预防的对比研究

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摘要目的观察比较利伐沙班与低分子肝素对老年糖尿病患者全髋关节置换术后DVT（深静脉血酸形成）的预防作用。　方法选择我院2014年5月～2015年8月择期行全髋关节置换术患者72例，经内科诊断为合并糖尿病。按随机数表法随机分为A组（利伐沙班组，n=36）和B组（低分子肝素组，n=36）。A组：术后10 h口服利伐沙班，剂量为10 mg，1次/d；B组术后10 h皮下注射低分子肝素，剂量为4100 IU。两组患者手术前后均行双下肢深静脉彩超，记录DVT的发生率和术后出血情况，检测术前及术后2、7、14 d的凝血指标及空腹血糖数值。结果A组DVT发病率（2.8%）低于B组（5.6%），差异无统计学意义（P＞0.05）；两组术后2、7 d D-二聚体值较术前明显升高，差异有统计学意义（P＜0.05），术后7、14 d D-二聚体值较第2 d有所下降，差异有统计学意义（P＜0.05），两组术后14 d的D-二聚体值比较，差异有统计学意义（P＜0.05），且A组术后D-二聚体降低的幅度大于B组；两组术后伤口出血情况比较，差异无统计学意义（P＞0.05）；两组各时点空腹血糖比较，差异无统计学意义（P＞0.05）；两组各时点凝血指标（PT、APTT）比较，差异无统计学意义（P＞0.05）。　结论利伐沙班与低分子肝素对老年糖尿病患者全髋关节置换术后深静脉血栓的形成均有预防作用，且利伐沙班的作用优于低分子肝素，同时出血无明显增加，对血糖的影响较小。

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	郝银丽
	高东艳
	张志强
	史锦绣

关键词 ：利伐沙班, 低分子肝素, 全髋关节置换术, 深静脉血栓, 糖尿病

Abstract：Objective To observe the prevention role of rivaroxaban and low molecular weight heparin in elderly diabetes patients with deep vein thrombosis after total hip replacement.Methods 72 patients who conducted total hip replacement underwent elective were selected from May 2014 to August 2015 of our hospital and diagnosed as diabetic from medical department.Patients were randomly divided into group A（rivaroxaban group，n=36）and group B（low molecular weight heparin group，n=36）according to random number table.Patients in group A were given oral administration rivaroxaban 10 h after operation and 10 mg once a day.Patients in group B were given hypodermic injection low molecular weight heparin 10 h after operation with the dose of 4100 IU.Both lower extremities deep veins color doppler ultrasound were conducted both before and after operation to record the incidence rate of deep venous thrombosis and postoperative bleeding.The coagulation markers that before operation and 2 days，7 days and 14 days after operation and fasting blood-glucose value were tested.Results The deep venous thrombosis rate in group A　（2.8%）was lower than that of group B（4.6%），and the difference had no statistical significance（P＞0.05）；the value of D-dimer increased obvious at 2 days and 7 days after operation in both two groups，and the difference was statistical significance（P＜0.05）；the value of D-dimer increased at 7 days and 14 days descended than at 2 days，and the difference was statistical significance（P＜0.05）；compared the D-dimer at 14 days between two group，the difference was statistical significance　（P＜0.05）and the decline scope of D-dimer in group A was more than that of group B；the postoperative bleeding in both two groups had no statistical significance（P＞0.05）；the fasting blood-glucose at all times in two groups had no statistical significance （P＞0.05）.Conclusion Both rivaroxaban and low molecular weight heparin have role in preventing elderly diabetes patients with deep vein thrombosis after total hip replacement.The role of rivaroxaban is better than low molecular weight heparin，there is no obvious increase bleeding and has little effect on blood-glucose.

Key words： Rivaroxaban Low molecular weight heparin Total hip replacement Deep vein thrombosis Diabetic

引用本文:

郝银丽;高东艳;张志强;史锦绣. 利伐沙班与低分子肝素对老年糖尿病患者全髋关节置换术后深静脉血栓预防的对比研究[J]. 中国当代医药, 2016, 23(10): 141-143转146.
HAO Yin-li;GAO Dong-yan;ZHANG Zhi-qiang;SHI Jin-xiu. Comparing the prevention role of rivaroxaban and low molecular weight heparin in elderly diabetes patients with deep vein thrombosis after total hip replacement. 中国当代医药, 2016, 23(10): 141-143转146.

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