2024 年第 1 期 第 0 卷

利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果分析

Perioperative application effect analysis of rivaroxaban and low molecular weight heparin in elderly patients with intertrochanteric fracture

作者：傅日斌 郑欣鹏 林劲松 覃基政 夏春

英文作者：Fu Ribin Zheng Xinpeng Lin Jinsong Qin Jizheng Xia Chun

单位：厦门大学附属中山医院关节外科与运动医学科，厦门361004

英文单位：Department of Joint Surgery and Sports Medicine Zhongshan Hospital Xiamen University Xiamen 361004 China

关键词：粗隆间骨折；利伐沙班；低分子肝素；下肢深静脉血栓形成

英文关键词：Intertrochantericfracture;Rivaroxaban;Lowmolecularweightheparin;Lowerextremitydeepvenousthrombosis

• 摘要：

• 目的  分析利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果。方法  选取2020年6月至2021年10月于厦门大学附属中山医院就诊的老年粗隆间骨折围手术期患者130例为研究对象。按随机数字表法分为观察组和对照组，每组65例。对照组采用低分子肝素皮下注射预防血栓，观察组采用利伐沙班口服预防血栓。比较2组患者术前及术后2周的凝血指标，术后2周内下肢深静脉血栓形成（DVT）和肺栓塞的发生率，术中出血量、术后引流量及住院时间，术后1 d炎症相关指标。结果  2组患者术前、术后2周组间和组内凝血相关指标差异均无统计学意义（均P>0.05）。术后观察组下肢DVT发生率显著低于对照组［4.6%（3/65）比15.4%（10/65）］，差异有统计学意义（χ2=4.188，P=0.041）。观察组与对照组术中出血量、术后引流量及住院时间差异均无统计学意义（均P>0.05）。术后1 d观察组降钙素原和C反应蛋白水平显著低于对照组［（0.17±0.02）μg/L比（0.22±0.01）μg/L、（20.2±2.3）mg/L比（23.9±3.6）mg/L］，差异均有统计学意义（均P＜0.001）。结论  利伐沙班与低分子肝素在老年粗隆间骨折患者围手术期均有良好的抗凝效果及安全性，但利伐沙班预防术后下肢DVT发生的效果更显著且口服用药更方便。

• Objective  To analyze the perioperative application effect of rivaroxaban and low molecular weight heparin in elderly patients with intertrochanteric fracture. Methods  Totally 130 elderly patients with intertrochanteric fractures in Zhongshan Hospital Xiamen University during the perioperative period from June 2020 to October 2021 were selected as the study subjects. They were divided into observation group and control group according to the random number table method, with 65 cases in each group. The control group was injected with low molecular weight heparin subcutaneously to prevent thrombosis, and the observation group was treated with rivaroxaban orally to prevent thrombosis. The blood coagulation indexes before and 2 weeks after operation, the incidences of lower extremity deep venous thrombosis (DVT) and pulmonary embolism within 2 weeks after operation, the amount of intraoperative bleeding, postoperative drainage volume, length of stay, and the inflammatory related indexes 1 d after operation were compared between the two groups. Results  There were no significant differences in coagulation related indicators between and within the two groups before and 2 weeks after operation(all P>0.05). The incidence of lower extremity DVT in the observation group after operation was significantly lower than that in the control group ［4.6%(3/65) vs 15.4%(10/65)］(χ2=4.188, P=0.041). There were no statistically significant differences in intraoperative bleeding volume, postoperative drainage volume, and length of stay between the two groups(all P>0.05). One day after operation, the levels of procalcitonin and C-reactive protein in the observation group were significantly lower than those in the control group［(0.17±0.02)μg/L vs (0.22±0.01)μg/L, (20.2±2.3)mg/L vs (23.9±3.6)mg/L］(both P<0.001). Conclusion  Rivaroxaban and low molecular weight heparin have good anticoagulant effect and safety in elderly intertrochanteric fracture patients during the perioperative period, but rivaroxaban has more significant effect in preventing postoperative lower extremity DVT, and oral administration is more convenient.