阿哌沙班对脊柱创伤患者椎弓根螺钉术后血液流变学、炎性因子及凝血功能的影响
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摘要
目的探讨阿哌沙班对脊柱创伤患者椎弓根螺钉术后血液流变学、炎性因子及凝血功能的影响。方法选取2014年1月—2016年12月收治的脊柱创伤98例,均行椎弓根螺钉术治疗,根据其术后应用药物的不同分为对照组46例和观察组52例,2组均予以术后常规及对症处理,对照组术后予以低分子肝素,观察组术后予以阿哌沙班。治疗结束后比较2组血液流变学、炎性因子及凝血功能相关指标水平,并记录2组治疗过程中不良反应发生情况。结果 2组治疗后血液流变学及炎性因子水平均较治疗前下降,且观察组低于对照组(P <0. 05)。2组治疗后凝血功能比较差异无统计学意义(P>0. 05)。2组均未出现明显严重不良反应。结论阿哌沙班可显著改善脊柱创伤患者椎弓根螺钉术后其血液流变学状况和降低其炎性因子水平,对凝血功能无明显影响,且具有一定的安全性。
Objective To investigate effects of Apixaban on hemorheology,inflammatory factors and coagulation function in treatment of patients with spinal trauma after pedicle screw surgery. Methods A total of 98 spinal trauma patients undergoing pedicle screw surgery during January 2014 and December 2016 were divided into control group( n = 46)and observation group( n = 52) according to different drugs use after surgery. All patients received postoperative symptomatic treatment,and then control group was treated with postoperative low molecular heparin,while observation group was treated with postoperative Apixaban. After operation,related indexes levels of hemorrheology,inflammatory factors,coagulation function were compared,and incidence rates of adverse reactions during the treatment were recorded in two groups. Results After treatment,levels of hemorheology and inflammatory factors were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group( P <0. 05). There was no significant difference in coagulation function between two groups after treatment( P > 0. 05). No serious adverse reactions were found in two groups. Conclusion Apixaban may significantly improve hemorheology condition and reduce levels of inflammatory factors in treatment of patients with spinal trauma after pedicle screw surgery with a certain safety,but it has no obvious effect on coagulation function.
Objective To investigate effects of Apixaban on hemorheology,inflammatory factors and coagulation function in treatment of patients with spinal trauma after pedicle screw surgery. Methods A total of 98 spinal trauma patients undergoing pedicle screw surgery during January 2014 and December 2016 were divided into control group( n = 46)and observation group( n = 52) according to different drugs use after surgery. All patients received postoperative symptomatic treatment,and then control group was treated with postoperative low molecular heparin,while observation group was treated with postoperative Apixaban. After operation,related indexes levels of hemorrheology,inflammatory factors,coagulation function were compared,and incidence rates of adverse reactions during the treatment were recorded in two groups. Results After treatment,levels of hemorheology and inflammatory factors were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group( P <0. 05). There was no significant difference in coagulation function between two groups after treatment( P > 0. 05). No serious adverse reactions were found in two groups. Conclusion Apixaban may significantly improve hemorheology condition and reduce levels of inflammatory factors in treatment of patients with spinal trauma after pedicle screw surgery with a certain safety,but it has no obvious effect on coagulation function.
引文
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[13]谭晶,孟钰童,张里程,等.创伤脊柱骨折患者术后深静脉血栓形成的发病危险因素分析[J].解放军医学院学报,2016,37(7):713-715,721.
[14]范竟一,孙琳,向莉,等.应用体积描记法测定婴幼儿型早发性脊柱侧弯的肺功能研究[J].解放军医药杂志,2017,29(8):22-26.
[15]黄焱.脊柱损伤经椎弓根螺钉固定治疗的临床疗效[J].实用心脑肺血管病杂志,2016,24(B4):81-82.
[16]郝宇鑫,吴子祥,杨照,等.膨胀式椎弓根螺钉在骨质疏松患者腰椎短节段固定融合手术中的临床应用[J].中国脊柱脊髓杂志,2017,27(2):136-141.
[17]黄志虎,张羽,张宣,等.微创手术与传统开放手术对胸腰段脊柱骨折患者的影响[J].创伤外科杂志,2017,19(10):784-786.
[18]胡乔军,周翰,邹佳瑜,等.后路胸椎椎弓根螺钉植入术治疗脊柱侧凸的CT影像学分析及近期疗效评价[J].中国CT和MRI杂志,2017,15(10):135-138.
[19]任婧娟,张楠,张扬,等.基于聚焦解决模式的心理护理对脊柱外科患者创伤后成长的影响[J].国际精神病学杂志,2017,43(4):732-735.
[20]刘美跃,王召红,张清.右美托咪定对老年脊柱骨科患者术后肺部并发症的影响[J].实用临床医药杂志,2017,21(15):192-194.
[21]王洪辉,闫毓鑫.脊柱创伤患者术后深静脉血栓发生及危险因素分析[J/CD].临床检验杂志:电子版,2017,6(3):536-537.
[22] Kim S K,Chung J Y,Seo H Y,et al. Vertebral compression fracture within a solid fusion mass without trauma after removal of pedicle screws[J]. Spine J,2016,16(3):e219-e223.
[23]孟繁星.脊柱胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析[J].世界中医药,2016,23(3):1030-1031.
[24]朱劲松,杨民,徐祝军,等.后路经椎弓根螺钉内固定治疗胸腰椎骨折治疗失败原因分析[J].中华创伤骨科杂志,2016,18(3):253-256.
[25]关永林,何万庆,李盛华,等.全脊柱椎弓根螺钉技术治疗脊柱侧凸疗效观察[J].颈腰痛杂志,2016,37(3):238-241.
[2]黄南翔,林宏,李伟.肝素对脊柱创伤PCS椎弓根螺钉术后患者血流变学及炎症细胞因子的影响[J].海南医学院学报,2016,22(22):2739-2741.
[3]王万宏,杜远立,熊家伟.后路减压植骨配合椎弓根螺钉内固定对胸腰段脊柱骨折合并脊髓损伤患者功能恢复的影响[J].现代中西医结合杂志,2016,25(34):3850-3852.
[4]曹在民,张雪松.脊柱外伤磁共振影像表现及损伤检出率研究[J].解放军医药杂志,2017,29(11):104-106.
[5]冯硕,田伟,刘波,等.微创导航对合并骨质疏松的脊柱手术患者椎弓根螺钉置钉效果的影响[J].山东医药,2017,57(26):70-72.
[6]王永强,刘晓光.影响骨质疏松患者椎弓根螺钉固定强度的相关技术进展[J].中国脊柱脊髓杂志,2016,26(5):466-470.
[7]邓潇,王国毓. 3节段以上椎弓根螺钉内固定应用于脊柱损伤治疗中的疗效分析[J].湖南中医药大学学报,2016,36(1):550-551.
[8]安振.经伤椎椎弓根植骨加椎弓根螺钉内固定治疗脊柱胸腰段爆裂性骨折的临床效果[J].保健医学研究与实践,2016,13(1):68-70.
[9]郭鸿飞,付君,张永刚,等.经椎弓根椎体截骨术治疗强直性脊柱炎后凸畸形患者术后肺功能的改变[J].中国脊柱脊髓杂志,2016,26(1):37-42.
[10] Alander D H,Cui S. Percutaneous Pedicle Screw Stabilization:Surgical Technique,Fracture Reduction,and Review of Current Spine Trauma Applications[J]. J Am Acad Orthop Surg,2018,26(7):231-240.
[11]陆焱,云雄,梁昌海,等.经伤椎椎弓根螺钉置入内固定术治疗无神经损伤腰椎骨折[J].局解手术学杂志,2016,25(9):658-661.
[12]郎明磊.脊柱椎弓根螺钉复位内固定术后患者医院感染临床特征及治疗方法[J].中国医药导报,2016,13(6):103-106.
[13]谭晶,孟钰童,张里程,等.创伤脊柱骨折患者术后深静脉血栓形成的发病危险因素分析[J].解放军医学院学报,2016,37(7):713-715,721.
[14]范竟一,孙琳,向莉,等.应用体积描记法测定婴幼儿型早发性脊柱侧弯的肺功能研究[J].解放军医药杂志,2017,29(8):22-26.
[15]黄焱.脊柱损伤经椎弓根螺钉固定治疗的临床疗效[J].实用心脑肺血管病杂志,2016,24(B4):81-82.
[16]郝宇鑫,吴子祥,杨照,等.膨胀式椎弓根螺钉在骨质疏松患者腰椎短节段固定融合手术中的临床应用[J].中国脊柱脊髓杂志,2017,27(2):136-141.
[17]黄志虎,张羽,张宣,等.微创手术与传统开放手术对胸腰段脊柱骨折患者的影响[J].创伤外科杂志,2017,19(10):784-786.
[18]胡乔军,周翰,邹佳瑜,等.后路胸椎椎弓根螺钉植入术治疗脊柱侧凸的CT影像学分析及近期疗效评价[J].中国CT和MRI杂志,2017,15(10):135-138.
[19]任婧娟,张楠,张扬,等.基于聚焦解决模式的心理护理对脊柱外科患者创伤后成长的影响[J].国际精神病学杂志,2017,43(4):732-735.
[20]刘美跃,王召红,张清.右美托咪定对老年脊柱骨科患者术后肺部并发症的影响[J].实用临床医药杂志,2017,21(15):192-194.
[21]王洪辉,闫毓鑫.脊柱创伤患者术后深静脉血栓发生及危险因素分析[J/CD].临床检验杂志:电子版,2017,6(3):536-537.
[22] Kim S K,Chung J Y,Seo H Y,et al. Vertebral compression fracture within a solid fusion mass without trauma after removal of pedicle screws[J]. Spine J,2016,16(3):e219-e223.
[23]孟繁星.脊柱胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析[J].世界中医药,2016,23(3):1030-1031.
[24]朱劲松,杨民,徐祝军,等.后路经椎弓根螺钉内固定治疗胸腰椎骨折治疗失败原因分析[J].中华创伤骨科杂志,2016,18(3):253-256.
[25]关永林,何万庆,李盛华,等.全脊柱椎弓根螺钉技术治疗脊柱侧凸疗效观察[J].颈腰痛杂志,2016,37(3):238-241.