脊髓损伤术后深静脉血栓预防的相关研究
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摘要
[目的]
研究利伐沙班预防创伤性脊髓损伤术后深静脉血栓形成的临床疗效和安全性。
[方法]
前瞻性纳入在本科室治疗资料完整的脊髓损伤患者80例,时间为2011年3月-2012年3月。分两组,一组为利伐沙班组,一组为空白对照组,比较2组病人手术后深静脉血栓和肺栓塞的发生率。
[结果]
共纳入病例80例,其中利伐沙班组38例,空白对照组42例；手术入路的方式为前路、后路或前后路联合；利伐沙班组中男性比例为73.7%,颈椎脊髓损伤的比例为64.3%,需要转康复科进一步治疗的比例为42.1%；空白对照组中男性比例占69.0%,颈椎脊髓损伤的患者比例为52.6%,需转康复科进一步治疗的患者比例为52.4%；利伐沙班组DVT的发生率2.7%,没有肺栓塞事件和死亡事件；空白对照组中深静脉血栓的发生率为28.3%,肺栓塞的发生率为14.29%,且均为颈椎脊髓损伤患者,致命性肺栓塞的发生率是2.4%,近端的DVT为2例,远端10例；有症状DVT有3例,无症状9例；有10例DVT和5例肺栓塞发生在转康复科治疗的过程中；两组比较,在深静脉血栓事件和肺栓塞事件方面差异有统计学意义(p<0.05)。在DVT的诊断方面,D-二聚体的阴性预测率是100%,阳性预测率是16.7%,可见D-二聚体可以作为排除深静脉血栓的一检测方法；在术后第四天的D-二聚体值,PT值、APTT值、TT值和术后拔除引流管的时间上两组没有统计学上的差异；利伐沙班组的术后引流量的比对照组多,但是没有统计学上的差异(P>0.05)；术后第四天的FIB两组比较有统计学意义(P<0.05),表明利伐沙班能降低血浆的FIB；利伐沙班组发生2例切口延迟愈合,胃肠道出血导致黑便1例,肝谷丙转氨酶升高超过正常值三倍3例；空白对照组发生切口延迟愈合1例。两组中均没有出现大出血事件,心血管事件和肾损害。两组比较药物的不良反应无统计学差异。
[结论]
利伐伐沙班可以降低脊髓损伤术后深静脉血栓和肺栓塞的发生率,且不增加术后出血、切口延迟愈合和肝损害等药物不良反应的风险。
[OBJECTIVEO]
To investigate the efficacy and safety of rivaroxaban prevention of spinal cord injury of deep vein thromosis.
[METHODS]
A prospective clinical trial was carried out in80consecutive patients with SCI who will have anterior, posterior or Anteior and posterior joint s decompr-ession surgery. The patient's admission time from March2011to February2012. Patients were randomly divided into two groups according to the date of admiss-ion. A group of patients taking rivaroxaban, a group of patients was the control group. To compare the incidence of deep vein thrombosis and pulmonary embolism.
[RESULTS]
A total of80cases was included, rivaroxaban38cases,42cases of blank control group. The Rivaroxaban group in the proportion of males was73.7%,64.3%of cervical spinal cord injury, the proportion of cases who needed to switch to rehabilitation department for further treatment was42.1%; the proportion of males accounted for69.0%of the blank control group; the proportion of patients for cervical spinal cord injury was52.6%; the proportion of patients who need to transfer to the rehabilitation department for further treatment was52.4%; In the rivaroxaban group, The incidence of DVT was 2.7%, There was no pulmonary embolism events and deaths; In the blank control group, the rate of deep vein thrombosis was28.3%;the rate of pulmonary embolism was14.29%and all patients had cervical spinal cord injury; the rate of fatal pulmonary embolism was2.4%; Two patients found to have proximal thrombosis,10patients with distal embolization; There are three patients with symptomatic thrombosis, nine patients with asymptomatic thrombosis.;10cases of DVT and5cases of PE occurred in the rehabilitation; The rate of deep venous thrombosis and pulmonary embolism in the groups have statistically significant difference (p<0.05). In the diagnosis of DVT, D-dimer negative predictive value100%, positive predictive value is11.5%. Visible D-dimer can be used as a detection method to exclude deep vein thrombosis; the fourth day after D-dimer values, after removal of the drainage tube on the two groups no statistically significant difference,also in the number of PT and APTT; to cutting postoperative drainage of the sand team more traffic than the control group, but no statistically significant difference (P>0.05); In the rivaroxaban grouo,there was2cases of delayed wound healing; One patient because of gastrointestinal bleeding cause the stool black; liver alanine transaminase elevation more than the normal twice3cases; In the blank control group, delayed wound healing one cases. No major bleeding events in both groups, cardiovascular events and kidney damage. The two groups the risk of bleeding was no significant difference.
[CONCLUSION]
Rivaroxaban can significantly reduce the incidence of postoperative deep vein thrombosis and pulmonary embolism of spinal cord injury; Rivaroxaban does not increase the risk of postoperative bleeding, wound infection and of liver function impairment.
研究利伐沙班预防创伤性脊髓损伤术后深静脉血栓形成的临床疗效和安全性。
[方法]
前瞻性纳入在本科室治疗资料完整的脊髓损伤患者80例,时间为2011年3月-2012年3月。分两组,一组为利伐沙班组,一组为空白对照组,比较2组病人手术后深静脉血栓和肺栓塞的发生率。
[结果]
共纳入病例80例,其中利伐沙班组38例,空白对照组42例；手术入路的方式为前路、后路或前后路联合；利伐沙班组中男性比例为73.7%,颈椎脊髓损伤的比例为64.3%,需要转康复科进一步治疗的比例为42.1%；空白对照组中男性比例占69.0%,颈椎脊髓损伤的患者比例为52.6%,需转康复科进一步治疗的患者比例为52.4%；利伐沙班组DVT的发生率2.7%,没有肺栓塞事件和死亡事件；空白对照组中深静脉血栓的发生率为28.3%,肺栓塞的发生率为14.29%,且均为颈椎脊髓损伤患者,致命性肺栓塞的发生率是2.4%,近端的DVT为2例,远端10例；有症状DVT有3例,无症状9例；有10例DVT和5例肺栓塞发生在转康复科治疗的过程中；两组比较,在深静脉血栓事件和肺栓塞事件方面差异有统计学意义(p<0.05)。在DVT的诊断方面,D-二聚体的阴性预测率是100%,阳性预测率是16.7%,可见D-二聚体可以作为排除深静脉血栓的一检测方法；在术后第四天的D-二聚体值,PT值、APTT值、TT值和术后拔除引流管的时间上两组没有统计学上的差异；利伐沙班组的术后引流量的比对照组多,但是没有统计学上的差异(P>0.05)；术后第四天的FIB两组比较有统计学意义(P<0.05),表明利伐沙班能降低血浆的FIB；利伐沙班组发生2例切口延迟愈合,胃肠道出血导致黑便1例,肝谷丙转氨酶升高超过正常值三倍3例；空白对照组发生切口延迟愈合1例。两组中均没有出现大出血事件,心血管事件和肾损害。两组比较药物的不良反应无统计学差异。
[结论]
利伐伐沙班可以降低脊髓损伤术后深静脉血栓和肺栓塞的发生率,且不增加术后出血、切口延迟愈合和肝损害等药物不良反应的风险。
[OBJECTIVEO]
To investigate the efficacy and safety of rivaroxaban prevention of spinal cord injury of deep vein thromosis.
[METHODS]
A prospective clinical trial was carried out in80consecutive patients with SCI who will have anterior, posterior or Anteior and posterior joint s decompr-ession surgery. The patient's admission time from March2011to February2012. Patients were randomly divided into two groups according to the date of admiss-ion. A group of patients taking rivaroxaban, a group of patients was the control group. To compare the incidence of deep vein thrombosis and pulmonary embolism.
[RESULTS]
A total of80cases was included, rivaroxaban38cases,42cases of blank control group. The Rivaroxaban group in the proportion of males was73.7%,64.3%of cervical spinal cord injury, the proportion of cases who needed to switch to rehabilitation department for further treatment was42.1%; the proportion of males accounted for69.0%of the blank control group; the proportion of patients for cervical spinal cord injury was52.6%; the proportion of patients who need to transfer to the rehabilitation department for further treatment was52.4%; In the rivaroxaban group, The incidence of DVT was 2.7%, There was no pulmonary embolism events and deaths; In the blank control group, the rate of deep vein thrombosis was28.3%;the rate of pulmonary embolism was14.29%and all patients had cervical spinal cord injury; the rate of fatal pulmonary embolism was2.4%; Two patients found to have proximal thrombosis,10patients with distal embolization; There are three patients with symptomatic thrombosis, nine patients with asymptomatic thrombosis.;10cases of DVT and5cases of PE occurred in the rehabilitation; The rate of deep venous thrombosis and pulmonary embolism in the groups have statistically significant difference (p<0.05). In the diagnosis of DVT, D-dimer negative predictive value100%, positive predictive value is11.5%. Visible D-dimer can be used as a detection method to exclude deep vein thrombosis; the fourth day after D-dimer values, after removal of the drainage tube on the two groups no statistically significant difference,also in the number of PT and APTT; to cutting postoperative drainage of the sand team more traffic than the control group, but no statistically significant difference (P>0.05); In the rivaroxaban grouo,there was2cases of delayed wound healing; One patient because of gastrointestinal bleeding cause the stool black; liver alanine transaminase elevation more than the normal twice3cases; In the blank control group, delayed wound healing one cases. No major bleeding events in both groups, cardiovascular events and kidney damage. The two groups the risk of bleeding was no significant difference.
[CONCLUSION]
Rivaroxaban can significantly reduce the incidence of postoperative deep vein thrombosis and pulmonary embolism of spinal cord injury; Rivaroxaban does not increase the risk of postoperative bleeding, wound infection and of liver function impairment.
引文
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