兩種抗凝藥物對人工全髖關節置換術隱性失血的影響比較_《中國修復重建外科雜志》

作者：

李軍 , 周云 , 荊玨華 , 詹俊鋒

安徽醫科大學第二附屬醫院骨科（合肥，230601）;

關鍵詞：

利伐沙班依諾肝素鈉人工全髖關節置換術隱性失血出血事件

DOI：

10.7507/1002-1892.20130100

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目的比較利伐沙班和依諾肝素鈉對人工全髖關節置換術（total hip arthroplasty，THA）后隱性失血的影響。方法回顧分析2009年6月－2012年1月76例（93髖）因股骨頭缺血性壞死接受初次THA患者的臨床資料，其中44例（54髖）從術后6～10 h開始每天口服利伐沙班10 mg，連用14 d（利伐沙班組）；32例（39髖）從術后12 h開始每日皮下注射依諾肝素鈉4 000 U，連用14 d（依諾肝素鈉組）。兩組患者性別、年齡、身高、體重、病程、股骨頭缺血性壞死分期及置換側別等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。兩組患者術前準備及術中處理均一致。比較兩組圍手術期實際失血總量、顯性失血量、隱性失血量及隱性失血量占實際失血總量百分比；記錄術后35 d內各組出血事件。結果利伐沙班組實際失血總量為（1 509.56 ± 325.23）mL，顯性失血量為（928.09 ± 210.50）mL，隱性失血量為（581.47 ± 215.01）mL，隱性失血量占實際失血總量百分比為37.88% ± 10.42%；依諾肝素鈉組分別為（1 521.38 ± 516.49）mL、（917.50 ± 378.73）mL、（603.88 ± 377.15）mL及38.18% ± 18.33%；兩組以上各指標比較，差異均無統計學意義（P gt; 0.05）。術后35 d內利伐沙班組出血事件發生率為9.1%（4/44），高于對照組的3.1%（1/32），但差異無統計學意義（χ2=1.073，P=0.390）。結論對于初次行THA的患者，圍手術期使用利伐沙班與依諾肝素鈉后隱性出血風險及出血事件發生率無顯著差異。

引用本文： 李軍,周云,荊玨華,詹俊鋒. 兩種抗凝藥物對人工全髖關節置換術隱性失血的影響比較. 中國修復重建外科雜志, 2013, 27(4): 432-435. doi: 10.7507/1002-1892.20130100 復制

1.	Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
2.	Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
3.	Huisman MV, Quinlan DJ, Dahl OE, et al. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty: Results of separate pooled analyses of phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes, 2010, 3(6): 652-660.
4.	Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
5.	Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
6.	高福強, 李子劍, 張克, 等. 初次全膝關節置換術后隱性失血的影響因素研究. 中華外科雜志, 2011, 49(5): 419-423.
7.	張鶴山, 李子榮. 股骨頭壞死診斷與治療的專家建議. 中華骨科雜志, 2007, 27(2): 146-148.
8.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
9.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
10.	李軍, 王健, 李陽, 等. 利伐沙班對人工全膝關節置換術后出血風險的影響. 中國修復重建外科雜志, 2011, 25(11): 1323-1325.
11.	Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3): 151-155.
12.	Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis, 1973, 32(6): 582-584.
13.	Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement. J R Coll Surg Edinb, 1981, 26(5): 295-297.
14.	Rama KR, Apsingi S, Poovali S, et al. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2007, 89(4): 699-705.
15.	Thorey F, Stukenborg-Colsman C, Windhagen H, et al. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care, 2008, 16(2): 85-92.
16.	叢宇, 趙建寧, 包倪榮, 等. 隱性失血對全髖關節置換術后功能恢復影響的臨床觀察. 中國骨傷, 2011, 24(6): 466-468.
17.	高玉鐳, 王東辰, 李佩佳, 等. 人工全髖關節置換術隱性失血量的估算及原因分析. 實用醫藥雜志, 2012, 29(6): 490-492.
18.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
19.	馬衛華, 張樹棟, 慕宏杰, 等. 低分子肝素使用時機對關節置換手術失血量和DVT發生率的影響. 中華骨科雜志, 2008, 28(10): 833-837.

1. Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
2. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
3. Huisman MV, Quinlan DJ, Dahl OE, et al. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty: Results of separate pooled analyses of phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes, 2010, 3(6): 652-660.
4. Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
5. Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
6. 高福強, 李子劍, 張克, 等. 初次全膝關節置換術后隱性失血的影響因素研究. 中華外科雜志, 2011, 49(5): 419-423.
7. 張鶴山, 李子榮. 股骨頭壞死診斷與治療的專家建議. 中華骨科雜志, 2007, 27(2): 146-148.
8. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
9. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
10. 李軍, 王健, 李陽, 等. 利伐沙班對人工全膝關節置換術后出血風險的影響. 中國修復重建外科雜志, 2011, 25(11): 1323-1325.
11. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3): 151-155.
12. Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis, 1973, 32(6): 582-584.
13. Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement. J R Coll Surg Edinb, 1981, 26(5): 295-297.
14. Rama KR, Apsingi S, Poovali S, et al. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2007, 89(4): 699-705.
15. Thorey F, Stukenborg-Colsman C, Windhagen H, et al. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care, 2008, 16(2): 85-92.
16. 叢宇, 趙建寧, 包倪榮, 等. 隱性失血對全髖關節置換術后功能恢復影響的臨床觀察. 中國骨傷, 2011, 24(6): 466-468.
17. 高玉鐳, 王東辰, 李佩佳, 等. 人工全髖關節置換術隱性失血量的估算及原因分析. 實用醫藥雜志, 2012, 29(6): 490-492.
18. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
19. 馬衛華, 張樹棟, 慕宏杰, 等. 低分子肝素使用時機對關節置換手術失血量和DVT發生率的影響. 中華骨科雜志, 2008, 28(10): 833-837.

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兩種抗凝藥物對人工全髖關節置換術隱性失血的影響比較

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