2020 年第 12 期 第 15 卷

氨甲环酸联合利伐沙班用于老年人工全髋关节置换术患者的有效性和安全性分析

Analysis of  effectiveness and safety of tranexamic acid combined with rivaroxaban on elderly patients underwent total hip arthroplasty

作者：韩杰斯焱张鹏朱江伟陈经勇

英文作者：Han Jie Si Yan Zhang Peng Zhu Jiangwei Chen Jingyong

单位：四川省骨科医院老年骨科，成都610041

英文单位：Department of Geriatric Orthopaedics Sichuan Provincial Orthopedics Hospital Chengdu 610041 China

关键词：人工全髋关节置换术；氨甲环酸；利伐沙班；隐性失血；血流动力学

英文关键词：Totalhiparthroplasty;Tranexamicacid;Rivaroxaban;Hiddenbloodloss;Hemodynamics

• 摘要：

• 目的 探讨氨甲环酸联合利伐沙班用于老年人工全髋关节置换术患者的有效性和安全性。方法 选取2016年7月至2019年7月于四川省骨科医院行人工全髋关节置换术的髋关节相关病变老年患者200例，应用随机数字表法分为对照组与观察组，各100例。对照组患者于人工全髋关节置换术后口服利伐沙班片治疗，连续服用35 d，观察组围术期给予氨甲环酸治疗，术后口服利伐沙班，用法用量与对照组一致。比较2组患者术中失血量、隐性失血量和显性失血量，治疗前后血常规和凝血酶原时间，以及术后不良反应和深静脉血栓发生率。结果 剔除未按研究方案治疗和未按规定检查的患者,观察组纳入93例、对照组纳入91例。观察组术中失血量、隐性失血量和显性失血量均少于对照组［(313±40)ml比（342±37）ml，(220±44)ml比（439±48）ml，(357±40)ml比（484±51）ml］（t=7.841、54.665、18.554，均P<0.001）。治疗后，2组患者凝血酶原时间均长于治疗前，且观察组长于对照组［(17.5±1.1)s比（14.8±1.1）s］（均P<0.05），但2组血红蛋白和血小板计数比较差异均无统计学意义（均P＞0.05）。观察组术后不良反应发生率和深静脉血栓发生率均低于对照组［19.4%(18/93）比33.0%（30/91），7.5%（7/93）比23.1%（21/91）］(χ2=5.661、9.327,P=0.017、0.002)。结论 氨甲环酸联合利伐沙班用于老年人工全髋关节置换术患者,能够有效降低患者术中失血量、隐性失血量和显性失血量，改善凝血酶原时间，降低深静脉血栓发生率。

• Objective To investigate the effictiveness and safety of tranexamic acid combined with rivaroxaban in elderly patients underwent total hip arthroplasty. Methods From July 2016 to July 2019, 200 elderly patients with hip related diseases who underwent total hip arthroplasty in Sichuan Provincial Orthopedics Hospital were selected and randomly divided into control group and observation group, with 100 cases in each group. The patients in the control group were treated with rivaroxaban tablets orally after total hip arthroplasty for 35 d continuously. The observation group was treated with tranexamic acid on the basis of the control group. The intraoperative blood loss, hidden blood loss and dominant blood loss, blood routine and prothrombin time before and after treatment, as well as the incidences of postoperative adverse reactions and deep vein thrombosis were compared between the two groups. Results After excluding the patients who were not treated according to the study protocol and not checked according to the regulations, 93 cases were included in the observation group and 91 cases were included in the control group. The intraoperative blood loss, hidden blood loss and dominant blood loss in the observation group were less than those in the control group ［(313±40)ml vs (342±37)ml, (220±44)ml vs (439±48)ml, (357±40)ml vs (484±51)ml］(t=7.841, 54.665, 18.554, all P<0.001). After treatment, prothrombin time in both groups were longer than that before treatment, and that in the observation group was longer than that in the control group ［(17.5±1.1)s vs (14.8±1.1)s］(all P<0.05), but there were no significant differences in hemoglobin and platelet count between the two groups (both P>0.05). The incidences of adverse reactions and deep vein thrombosis in the observation group were lower than those in the control group ［19.4%(18/93) vs 33.0%(30/91), 7.5%(7/93) vs 23.1%(21/91)］(χ2= 5.661, 9.327, P=0.017, 0.002). Conclusion sTranexamic acid combined with rivaroxaban in elderly patients underwent total hip arthroplasty can effectively reduce intraoperative blood loss, hidden blood loss and dominant blood loss, improve prothrombin time and reduce the incidence of deep vein thrombosis.