天津医药

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高龄股骨转子间骨折围手术期不同抗凝药物疗效分析

刘宾1,张亮2   

  1. 1. 天津医科大学第二医院
    2. 天津医科大学第二医院骨科
  • 收稿日期:2013-04-15 修回日期:2013-05-29 出版日期:2013-08-15 发布日期:2013-08-15
  • 通讯作者: 刘宾

Analysis of the different perioperative anticoagulant effects for the elders with intertrochanteric fracture

Bin LIU 2   

  • Received:2013-04-15 Revised:2013-05-29 Published:2013-08-15 Online:2013-08-15
  • Contact: Bin LIU

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摘要： 【摘要】 目的 比较利伐沙班与低分子肝素对高龄股骨转子间骨折患者围手术期的抗凝疗效。 方法 选择行手术治疗的高龄股骨转子间骨折患者 122例， 其中低分子肝素抗凝组 62例， 利伐沙班抗凝组 60例。 比较2组术中出血量、伤口愈合时间、换药次数及术后深静脉血栓发生率。 结果 2组的术中出血量、伤口愈合时间、换药次数及深静脉血栓发生率差异无统计学意义（P＞ 0.05）。 低分子肝素组 4 例出现皮下淤斑， 1 例患者出现血小板减少， 利伐沙班组未出现并发症。 结论 口服利伐沙班对高龄股骨转子间骨折抗凝效果好， 患者依从性好， 值得临床推广应用。

关键词: 股骨, 髋骨折, 老年人, 肝素, 低分子量, 利伐沙班, 手术期间

Abstract: Objective    In order to compare the perioperative anticoagulant effect of Rlvaroxaban with that of low molecular heparin calcium for elders with intertrochanteric fracture. Method    We have retrospectively analyzed the anticoagulant effect of 122 elders with intertrochanteric fracture, who were in hospital between March 2008 and January 2012 and have all underwent a surgery. Of the patients 62 received the treatment with low molecular heparin calcium, and 60 were treated with Rlvaroxaban. We have compared the mean operative blood loss, mean wound healing time and mean wound dressing time, and evaluated the two groups’ rate of deep venous thrombosis. Result   There is no significance in mean operative blood loss, mean wound healing time and mean wound dressing time between two groups（P＞0.05）. There are 6 cases formed thrombosis in group with low molecular heparin calcium and 4 cases formed thrombosis in group with Rlvaroxaban, 2 cases of 6 patients formed thrombosis after discharge. There is no significance in the two groups’ rate of deep venous thrombosis（P＞0.05）.But subcutaneous ecchymosis has formed in 4 cases and the count of platelet reduced in one case in group with low molecular heparin calcium, and there is no case with complications in group with Rlvaroxaban. Conclusion    Rlvaroxaban and low molecular heparin calcium both have a good perioperative anticoagulant effect for elders with intertrochanteric fracture. But there is low patient compliance for hypodermic injection of low molecular heparin calcium, and some cases subcutaneous ecchymosis have formed and the count of platelet reduced in some cases, patients have a high risk of deep venous thrombosis because of no treatment after discharge. There is a high patient compliance for oral therapy of Rlvaroxaban, and patients can also continue taking after discharge, and it is an anticoagulant drug with the advantage of excellent effect and convenient taking.

Key words: femur, hip fracture, aged, heparin, low-molecular-weight, Rivaroxaban, intraoperative period