摘要
目的观察利伐沙班在老年股骨转子间骨折患者闭合复位内固定术围术期中的作用及对术后切口愈合的影响，并评估术后至切口拆线前使用该药物的安全性及可行性。方法选取2011年6月～2012年12月大连医科大学附属第一医院创伤骨科146例股骨转子间骨折患者．随机分为3组，分别采用物理疗法、皮下注射低分子量肝素、13服利伐沙班治疗。记录术后切口渗血量，平均拆线时间，12天内拆线数，不良切口发生率，术前和术后1、3、7d的胛及AHT值，下肢深静脉血栓（DVT）和肺栓塞（PE）发生率，并进行比较。结果物理疗法组切口渗血量为（48．2±5．0）ml，低分子量肝素组为（47．1±5．4）ml，利伐沙班组为（49．6±4．8）ml，差异无统计学意义（P〉0．05）。物理疗法组平均拆线时间为（13．0±2．0）d，低分子量肝素组为（12．5±2．5）d，利伐沙班组为（13．0±1．5）d，差异无统计学意义（P〉0．05）。物理治疗组12天内拆线数为48例（98．0％），低分子量肝素组为46例（95．8％），利伐沙班组为39例（79．6％），差异无统计学意义（D0．05）。物理治疗组不良切口发生率为2．0％，低分子量肝素组为4．2％，利伐沙班组为20．4％。差异有统计学意义（P〈0．05）。3组患者术前和术后1、3、7d的PT及APTT值比较，差异无统计学意义（P〉0．05）。物理疗法组DVT发生率为44．9％，低分子量肝素组为18．8％，利伐沙班组为6．1％，差异有统计学意义（P〈0．05）。物理疗法组PE发生率为20．4％，低分子量肝素组为10．4％，利伐沙班组为2．0％，差异有统计学意义（P〈0．05）。结论利伐沙班虽然会导致股骨转子间骨折患者术后切口愈合时间延长，但其不会引起凝血象改变，且在预防DVT及PE方面，效果优于物理疗法及低分子量肝素。
Objective To observe the function and effect of rivaroxaban in the perioperative period of intertrochanteric fracture and to wound healing,to evaluate the safety and feasibility of rivaroxaban treatment from postoperative time to stitch removal time.Methods 146 patients with intertrochanteric fracture admitted to the first affiliated hospital of Dalian Medical University from June 2011 to December 2012 were selected and randomly divided into three groups, physical therapy,subcutaneous low molecular weight heparin,oral rivaroxaban treatment was used respectively.Incision bleeding volume,average stitches time,the number of stitches within 12 days,the incidence rate of adverse incision,preoperative and postoperativel,3,7-day PT and APTT values,deep vein thrombosis（DVT）and pulmonaryembolism（PE）incidenee rate were recorded and compared.Results Incision bleeding volume of physical therapy group was（48.2±5.0） ml, incision bleeding volume of low molecular weight heparin group was（47.1±5.4） ml,incision bleeding volume of rivarox- aban group was （49.6±4.8） ml,with no statistical difference （P〉0.05）.Average stitches time of physical therapy group were （13.0±2.0）days,average stitches time of low molecular weight heparin group were （12.5±2.5）days,average stitches time of rivaroxaban group were （13.0±1.5）days,with no statistical difference （P〉0.05）.The number of stitches within 12 days of physical therapy group were 48 cases （98.0%）,the number of stitches within 12 days of low＇ molecular weight heparin group were 46 eases（95.8%）,the number of stitches within 12 days of rivaroxaban group were 39 cases（79.6%）, with no statistical difference（P〉0.05）.The incidence rate of adverse incision of physical therapy group was 2.0%,the incidence rate of adverse incision of low molecular weight heparin group was 4.2%,the incidence rate of adverse incision of rivaroxaban group was 20.4%,with statistical difference （P〈0.05）.Three groups of patients before and after surgery 1,3,7-day of PT and APTT value were compared,with no statistical difference （P〉0.05）.DVT incidence rate of physical therapy group was 44.9%,DVT incidence rate of low molecular weight heparin group was 18.8%,DVT incidence rate of adverse incision of rivaroxaban group was 6.1%,with statistical difference（P〈0.05）.PE incidence rate of physical thera- py group was 20.4%,PE incidence rate of low molecular weight heparin group was 10.4%,PE incidence rate of adverse incision of rivaroxaban group was 2.0%,with statistical difference（P〈0.05）.Conclusion Although rivaroxaban will result in intertrochanteric fracture patients prolonged postoperative wound healing,but it does not cause clotting like to change,and in the prevention of DVT and PE,the effect is better than that of physical therapy and low molecular weight heparin.
出处
《中国当代医药》
2013年第34期98-100,共3页
China Modern Medicine
关键词
利伐沙班
股骨转子间骨折
切口愈合时间
静脉血栓
Rivaroxaban
Intertrochanteric fracture
Time of wound healing
Venous thrombosis
