老年腰椎患者术后应用利伐沙班的凝血功能变化及对深静脉血栓的预防

The change of blood coagulation by applying rivaroxaban and its effect on preventing venous thromboembolism after lumbar spine surgery in elderly

中文关键词:  利伐沙班  血栓弹力图  腰椎术后  下肢深静脉血栓

英文关键词:Rivaroxaban  Thromboelastography  Post lumbar surgery  Deep venous thrombosis

中文摘要:

  【摘要】 目的：观察老年腰椎患者术后使用利伐沙班的凝血功能变化，评估其预防下肢深静脉血栓的有效性及安全性。方法：选取我院2012年3月～2015年12月收治的老年腰椎疾病患者220例，随机分为利伐沙班组（110例，A组）和低分子肝素组（110例，B组），术后2周每日分别使用利伐沙班 （10mg，口服）和低分子肝素钙（5000 IU，皮下注射）抗凝。于术前、术后1d、4d行血栓弹力图检查（包括凝血反应时间R值、血细胞凝集块形成时间K值、凝固角α角和最大振幅MA值）动态观察凝血功能变化，并对比分析两组患者下肢深静脉血栓发生率、出血性并发症和术后48h引流量。结果：A、B两组患者术后血栓弹力图中R值（5.87±0.83min，5.72±0.68min）和K值（1.56±0.30min，1.49±0.34min）均较术前（7.27±0.89min，7.45±0.79min；2.06±0.29min，2.11±0.30min）减小（P=0.000），α角（66.21°±3.75°，67.00°±3.43°）和MA值（62.94±3.57mm，63.65±5.06mm）均较术前（62.17±3.59mm，61.39±4.00mm；58.92±3.24mm，58.20±3.26mm）增大（P=0.000），提示血液凝固性增高。短期使用（4d）利伐沙班或低分子肝素后，两组R值（6.97±0.69min，7.07±0.67min）和K值（1.97±0.31min，2.04±0.32min）均增大（P=0.000），α角（61.41°±4.04°，62.16°±4.13°）和MA值（58.15±2.97mm，58.57±4.41mm）均减小（P=0.000），提示高凝状态均得到较好的纠正，两组间比较无统计学差异（P>0.05）。在两周随访期内，A组和B组分别有9例（8.18%）、6例（5.45%）出现了无症状性下肢深静脉血栓，两组间比较无统计学差异（χ2=0.64，P=0.422）；两组分别有9例（8.18%）和7例（6.36%）患者出现了出血性并发症，其中严重出血并发症分别为2例和1例（均为硬膜外血肿，行硬膜外血肿清除术后好转），两组间比较无统计学差异（χ2=0.27，P=0.604）；两组间术后48h引流量（412.30±44.65ml，421.71±43.45ml）也无统计学差异（t=-1.58，P=0.115）。结论：老年腰椎患者术后血液凝固性增高，使用利伐沙班或低分子肝素均能较好纠正高凝状态；同时，对于老年腰椎术后下肢深静脉血栓形成的预防，利伐沙班具有与低分子肝素相似的有效性和安全性。

英文摘要:

  【Abstract】 Objectives: To observe the change of blood coagulation by applying rivaroxaban after lumbar spine surgery in elderly, and to evaluate its effectiveness and safety for preventing deep venous thrombosis(DVT). Methods: 220 patients who underwent lumbar surgery in our hospital from March 2012 to December 2015, were randomly assigned to rivaroxaban group(n=110) and parnaparin group(n=110). Rivaroxaban(10mg) and low-molecular-weight heparin calium (5000 IU) were used for anticoagulant therapy. The changes of blood coagulation were observed before surgery and on 1 and 4 days after surgery through thromboelastography (TEG), including coagulation reaction time(R), blood cell clot formation time(K), angle of solidification(α) and maximal amplitude(MA). The occurrence rate of DVT, hemorrhagic complication and volume of drainage at 48h were analyzed. Results: TEG of both groups showed that the R time(5.87±0.83min, 5.72±0.68min) and K time(1.56±0.30min, 1.49±0.34min) at postoperation were significantly shorter than those before operation(7.27±0.89min, 7.45±0.79min; 2.06±0.29min, 2.11±0.30min respectively)(P=0.000), while the α angle(66.21°±3.75°, 67.00°±3.43°) and MA(62.94±3.57mm, 63.65±5.06m) were significantly higher than those before operation(62.17°±3.59°, 61.39°±4.00°; 58.92±3.24mm, 58.20±3.26mm respectively)(P=0.000), suggesting an increase of blood clotting. After intervention(4 days), the R time(6.97±0.69min, 7.07±0.67min) and K time(1.97±0.31min, 2.04±0.32min) increased significantly(P=0.000), and the α angle(61.41°±4.04°, 62.16°±4.13°) and MA(58.15±2.97mm, 58.57±4.41mm) decreased significantly(P=0.000), suggesting that the high coagulation states of both groups were corrected, no significant difference between the two groups was noted(P>0.05). There were 9 asymptomatic DVT events(8.18%) in rivaroxaban group during 2-week follow-up while 6(5.45%) in parnaparin group, the difference between the two groups was not significant(χ2=0.64, P=0.422). There were 9 cases with bleeding events(8.18%) in rivaroxaban group while 7(6.36%) in parnaparin group, the difference between the two groups was not significant(χ2=0.27, P=0.604). And the volumes of drainage at 48h of two groups(412.30±44.65 ml, 421.71±43.45 ml, respectively) had no significant difference(t=-1.58, P=0.115). Conclusions: The blood coagulation increases after lumbar spine surgery in elderly. It can be corrected by rivaroxaban or low-molecular-weight heparin calium. And the effectiveness and safety between them for preventing DVT are equal.