两种抗凝药物对人工全髋关节置换术隐性失血的影响比较_《中国修复重建外科杂志》

作者：

李军 , 周云 , 荆珏华 , 詹俊锋

安徽医科大学第二附属医院骨科（合肥，230601）;

关键词：

利伐沙班依诺肝素钠人工全髋关节置换术隐性失血出血事件

DOI：

10.7507/1002-1892.20130100

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的比较利伐沙班和依诺肝素钠对人工全髋关节置换术（total hip arthroplasty，THA）后隐性失血的影响。方法回顾分析2009年6月－2012年1月76例（93髋）因股骨头缺血性坏死接受初次THA患者的临床资料，其中44例（54髋）从术后6～10 h开始每天口服利伐沙班10 mg，连用14 d（利伐沙班组）；32例（39髋）从术后12 h开始每日皮下注射依诺肝素钠4 000 U，连用14 d（依诺肝素钠组）。两组患者性别、年龄、身高、体重、病程、股骨头缺血性坏死分期及置换侧别等一般资料比较，差异均无统计学意义（P gt; 0.05），具有可比性。两组患者术前准备及术中处理均一致。比较两组围手术期实际失血总量、显性失血量、隐性失血量及隐性失血量占实际失血总量百分比；记录术后35 d内各组出血事件。结果利伐沙班组实际失血总量为（1 509.56 ± 325.23）mL，显性失血量为（928.09 ± 210.50）mL，隐性失血量为（581.47 ± 215.01）mL，隐性失血量占实际失血总量百分比为37.88% ± 10.42%；依诺肝素钠组分别为（1 521.38 ± 516.49）mL、（917.50 ± 378.73）mL、（603.88 ± 377.15）mL及38.18% ± 18.33%；两组以上各指标比较，差异均无统计学意义（P gt; 0.05）。术后35 d内利伐沙班组出血事件发生率为9.1%（4/44），高于对照组的3.1%（1/32），但差异无统计学意义（χ2=1.073，P=0.390）。结论对于初次行THA的患者，围手术期使用利伐沙班与依诺肝素钠后隐性出血风险及出血事件发生率无显著差异。

引用本文： 李军,周云,荆珏华,詹俊锋. 两种抗凝药物对人工全髋关节置换术隐性失血的影响比较. 中国修复重建外科杂志, 2013, 27(4): 432-435. doi: 10.7507/1002-1892.20130100 复制

1.	Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
2.	Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
3.	Huisman MV, Quinlan DJ, Dahl OE, et al. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty: Results of separate pooled analyses of phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes, 2010, 3(6): 652-660.
4.	Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
5.	Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
6.	高福强, 李子剑, 张克, 等. 初次全膝关节置换术后隐性失血的影响因素研究. 中华外科杂志, 2011, 49(5): 419-423.
7.	张鹤山, 李子荣. 股骨头坏死诊断与治疗的专家建议. 中华骨科杂志, 2007, 27(2): 146-148.
8.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
9.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
10.	李军, 王健, 李阳, 等. 利伐沙班对人工全膝关节置换术后出血风险的影响. 中国修复重建外科杂志, 2011, 25(11): 1323-1325.
11.	Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3): 151-155.
12.	Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis, 1973, 32(6): 582-584.
13.	Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement. J R Coll Surg Edinb, 1981, 26(5): 295-297.
14.	Rama KR, Apsingi S, Poovali S, et al. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2007, 89(4): 699-705.
15.	Thorey F, Stukenborg-Colsman C, Windhagen H, et al. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care, 2008, 16(2): 85-92.
16.	丛宇, 赵建宁, 包倪荣, 等. 隐性失血对全髋关节置换术后功能恢复影响的临床观察. 中国骨伤, 2011, 24(6): 466-468.
17.	高玉镭, 王东辰, 李佩佳, 等. 人工全髋关节置换术隐性失血量的估算及原因分析. 实用医药杂志, 2012, 29(6): 490-492.
18.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
19.	马卫华, 张树栋, 慕宏杰, 等. 低分子肝素使用时机对关节置换手术失血量和DVT发生率的影响. 中华骨科杂志, 2008, 28(10): 833-837.

1. Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
2. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
3. Huisman MV, Quinlan DJ, Dahl OE, et al. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty: Results of separate pooled analyses of phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes, 2010, 3(6): 652-660.
4. Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
5. Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
6. 高福强, 李子剑, 张克, 等. 初次全膝关节置换术后隐性失血的影响因素研究. 中华外科杂志, 2011, 49(5): 419-423.
7. 张鹤山, 李子荣. 股骨头坏死诊断与治疗的专家建议. 中华骨科杂志, 2007, 27(2): 146-148.
8. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
9. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
10. 李军, 王健, 李阳, 等. 利伐沙班对人工全膝关节置换术后出血风险的影响. 中国修复重建外科杂志, 2011, 25(11): 1323-1325.
11. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3): 151-155.
12. Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis, 1973, 32(6): 582-584.
13. Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement. J R Coll Surg Edinb, 1981, 26(5): 295-297.
14. Rama KR, Apsingi S, Poovali S, et al. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2007, 89(4): 699-705.
15. Thorey F, Stukenborg-Colsman C, Windhagen H, et al. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care, 2008, 16(2): 85-92.
16. 丛宇, 赵建宁, 包倪荣, 等. 隐性失血对全髋关节置换术后功能恢复影响的临床观察. 中国骨伤, 2011, 24(6): 466-468.
17. 高玉镭, 王东辰, 李佩佳, 等. 人工全髋关节置换术隐性失血量的估算及原因分析. 实用医药杂志, 2012, 29(6): 490-492.
18. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
19. 马卫华, 张树栋, 慕宏杰, 等. 低分子肝素使用时机对关节置换手术失血量和DVT发生率的影响. 中华骨科杂志, 2008, 28(10): 833-837.

上一篇
可吸收棒在Salter术中重建骨盆稳定性的应用
下一篇
膝关节多发韧带损伤中后外侧复合体的解剖重建

《中国修复重建外科杂志》

两种抗凝药物对人工全髋关节置换术隐性失血的影响比较

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国修复重建外科杂志》

两种抗凝药物对人工全髋关节置换术隐性失血的影响比较

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料