[1]胡鸿鹏,刘泽明,高勇岗,等.吲哚布芬预防老年髋关节置换术后下肢深静脉血栓的临床研究[J].中华老年骨科与康复电子杂志,2019,(01):19-24.[doi:10.3877/cma.j.issn.2096-0263.2019.01.005]
　Hu Hongpeng,Liu Zeming,Gao Yonggang,et al.Clinical study of indolbufen in preventing deep vein thrombosis of lower extremity after hip arthroplasty in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(01):19-24.[doi:10.3877/cma.j.issn.2096-0263.2019.01.005]
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吲哚布芬预防老年髋关节置换术后下肢深静脉血栓的临床研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年01期
页码:
19-24
栏目:
髋部骨折
出版日期:
2019-02-05

文章信息/Info

Title:
Clinical study of indolbufen in preventing deep vein thrombosis of lower extremity after hip arthroplasty in elderly patients
作者:
胡鸿鹏; 刘泽明; 高勇岗; 马文辉; 姚孟轩; 李梦男; 秦迪; 李会杰; 韩永台
050051 石家庄，河北医科大学第三医院骨病科
Author(s):
Hu Hongpeng;  Liu Zeming;  Gao Yonggang;  Ma Wenhui;  Yao Mengxuan;  Li mengnan;  Qin Di;  Li Huijie;  Han Yongtai.
Bone Disease Department, theThirdHospital of Hebei Medical University, Shijiazhuang 050051, China
关键词:
静脉血栓形成;  关节成形术; 置换; 髋;  老年人;  吲哚布芬
Keywords:
Venous thrombosis;  Arthroplasty;  replacement;  hip;  Aged;  Indolbufen
DOI:
10.3877/cma.j.issn.2096-0263.2019.01.005
文献标志码:
A
摘要:
目的 探讨吲哚布芬预防老年患者髋关节置换术后下肢深静脉血栓（DVT）的疗效及安全性。方法 前瞻性收集河北医科大学第三医院骨病科2017年1月至2017年8月因非外伤性原因行初次全髋关节置换的60岁以上患者100例。随机将100例患者分为两组，A组（50例）采用吲哚布芬200 mg，2/日抗凝治疗，B组（50例）采用利伐沙班10 mg，1/日抗凝治疗，两组抗凝药使用均不少于35 d，观察并对比两组血栓发生率、失血量及凝血功能等指标。结果 100例中共发生13例DVT，A组6例（12%）术后发生静脉血栓：肌间静脉血栓4例，胫后/腓静脉血栓2例。B组7例（14%）术后发生静脉血栓：肌间静脉血栓5例，胫后/腓静脉血栓2例。两组均未出现腘静脉及腘静脉以上严重血栓。A组和B组下肢DVT发生情况比较，差异无统计学意义（c2=0.123，P=0.941）。两组患者术后1 d引流量均比2 d多，差异有统计学意义（A组：t=41.901，P＜0.05；B组：t=31.185，P＜0.05）；两组患者术前血红蛋白均正常，术后1 d下降，术后7 d基本和术后1 d持平，组内不同时点间血红蛋白差异有统计学意义（F=17.688，P＜0.001），两组间各时间点血红蛋白差异无统计学意义（F=0.724，P=0.399）。两组PT、APTT和INR术后呈上下波动，组内不同时点间差异有统计学意义（F=10.635，P＜0.001；F=5.020，P=0.008；F=9.147，P＜0.001）；两组FIB、D-Dimmer也呈上下波动，组间（F=4.414，P=0.041；F=11.867，P＜0.001）及组内不同时点间（F=88.996，P＜0.001；F=103.021，P＜0.001）差异均有统计学意义。结论 与利伐沙班相比，吲哚布芬预防老年患者髋关节置换术后下肢DVT发生率相似，不显著增加患者的术后失血。
Abstract:
Objective To discuss the efficacy and safety of indolbufen in prevention of deep venous thrombosis after hip arthroplasty in elderly patients. Methods A total of 100 tramatic patients who underwent primary total hip arthroplasty from January 2017 to August 2017 in the department of orthopedics, the third hospital of hebei medical university were collected. 100 patients were randomly divided into two groups: group A (50 cases) was treated with 200 mg of indolebufen, 2/d, and group B (50 cases) was treated with 10 mg of rivaroxaban and 1/d anticoagulant. Anticoagulants were used for at least 35 days in both groups. We observed and compared the incidence of thrombosis, blood loss and coagulation function between the two groups. Results There were 13 DVT in 100 cases. In group A, 6 cases (12%) had postoperative venous thrombosis, 4 cases had intramuscular venous thrombosis, and 2 cases had posterior tibial/peroneal venous thrombosis. In group B, 7 cases (14%) had postoperative venous thrombosis, 5 cases had intramuscular venous thrombosis, and 2 cases had posterior tibial/peroneal venous thrombosis. No serious popliteal vein or femoral vein thrombosis occurred in either group. There was no statistically significant difference between group A and group B in the incidence of lower extremity deep vein thrombosis (c2=0.123, P=0.941). The drainage of patients in both groups was higher on day 1 after surgery than that on day 2 after surgery, and the difference between the drainage on day 1 after surgery and that on day 2 after surgery was statistically significant (group A: t=41.901, P<0.05; Group B: t= 31.185, P<0.05); Patients in both groups had normal preoperative hemoglobin, decreased hemoglobin on the first day after surgery, and almost equal hemoglobin on the seventh day after surgery and the first day after surgery. There was statistically significant difference in hemoglobin between the two groups at different time points (F=17.688, P<0.001). There was no statistically significant difference in hemoglobin between the two groups at different time points (F=0.724, P=0.399). Postoperative PT, APTT and INR of the two groups fluctuated up and down, with only statistical difference in time points (F=10.635, P<0.001; F=5.020, P=0.008; F=9.147, P<0.001). FIB and d-dimmer also fluctuated up and down in the two groups, and there were statistical differences between the groups (F=4.414, P=0.041; F=11.867, P<0.001) and between the time points (F=88.996, P<0.001; F=103.021, P<0.001). Conclusion Compared with rivaroxaban, the incidence of deep vein thrombosis in lower extremities after hip arthroplasty was similar in indobufen prevention in elderly patients, with no significant increase in postoperative blood loss.

参考文献/References:

1 Zhang H, Mao P, Wang C, et al. Incidence and risk factors of deep vein thrombosis (DVT) after total hip or knee arthroplasty: a retrospective study with routinely applied venography [J]. Blood Coagul Fibrinolysis, 2017, 28(2): 126-133.
2 Jurk K, Kehrel BE. [Pathophysiology and biochemistry of platelets][J]. Internist, 2010, 51(9):1086-1094.
3 Streiff MB, Agnelli G, Connors JM, et al. Guidance for the treatment of deep vein thrombosis and pulmonary embolism [J]. J Thromb Thrombolysis, 2016, 41(1): 32-67.
4 Lee SY, Ro du H, Chung CY, et al. Incidence of deep vein thrombosis after major lower limb orthopedic surgery: analysis of a nationwide claim registry [J]. Yonsei Med J 2015, 56(1): 139-145.
5 Righini M, Galanaud JP, Le Gal G. Anticoagulant therapy for symptomatic calf deep vein thrombosis [J]. Lancet Haematol, 2017, 4(4): 156.
6 张成梅, 尹志圣, 武传涛, 等. 吲哚布芬对血小板聚集及血栓形成的影响 [J]. 山东大学学报:医学版, 2010, 48(12): 37-41.
7 O’brien J, Duncan H, Kirsh G, et al. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial [J]. Lancet, 2000, 355(9212): 1295-1302.
8 Bahl V, Hu HM, Henke PK, et al. A validation study of a retrospective venous thromboembolism risk scoring method [J]. Ann Surg, 2010, 251(2): 344-350.
9 范忠诚, 曹亮, 张寿, 等. 不同氨甲环酸应用方法对老年股骨头置换术引流量的影响 [J]. 中华老年骨科与康复电子杂志, 2018, 4(3): 137-140.
10 杨雄刚, 胡永成, 赵立明. 老年骨科患者血栓预防的研究现状 [J]. 中华老年骨科与康复电子杂志, 2018, 4(2): 65-69.
11 裴宝瑞, 吴啸波, 李力更, 等. 应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究 [J]. 中华老年骨科与康复电子杂志, 2016, 2(2): 76-80.
12 马信龙, 张建敏, 马剑雄, 等. 骨科大手术后静脉血栓栓塞症的研究进展 [J]. 中华骨科杂志, 2016, 36(15): 995-1001.
13 楚翔宇, 程文俊, 王俊文, 等. 老年股骨颈骨折全髋关节置换术围手术期下肢深静脉血栓形成的特点 [J]. 中华老年骨科与康复电子杂志, 2018, 4(2): 75-79.
14 Rostagno C. Prophylaxis of venous thromboembolism in major orthopedic surgery:a practical approach [J]. Cardiovasc Hematol Agents Med Chem, 2013, 11(3): 230-242.
15 陈宾, 林凤飞, 林朝晖, 等. 低分子肝素钙治疗老年创伤后急性深静脉血栓的临床应用 [J]. 中华老年骨科与康复电子杂志, 2018, 4(2): 86-91.
16 李岚, 徐燕红. 改良注射法在低分子肝素钠皮下注射中的应用价值 [J]. 内蒙古中医药, 2012, 31(7): 31-32.
17 Vargas Ruiz AG, Ramírez López AN, Medina Viramontes ME. New anticoagulants: dabigatran, rivaroxaban and apixaban [J]. Gac Med Mex, 2012, 148(3): 257-264.
18 Lassen MR, Haas S, Kreutz R, et al. Rivaroxaban for thromboprophylaxis after Fracture-Related orthopedic surgery in routine clinical practice [J]. Clin Appl ThrombHemost, 2016, 22(2): 138-146.
19 Eriksson B, Borris LC, Friedman RJ. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty [J]. N Engl J Med, 2008, 358(26): 2765-2775.
20 Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate [J]. Clin Pharmacokinet, 2008, 47(5): 285-295.
21 中华医学会心血管病学分会, 中国老年学学会心脑血管病专业委员会. 老年高血压的诊断与治疗中国专家共识(2011版) [J]. 中国医学前沿杂志:电子版, 2012, 4(2): 31-39.
22 Garry J, Duke A, Labropoulos N. Systematic review of the complications following isolated calf deep vein thrombosis [J]. BrJSurg, 2016, 103(7): 789-796.
23 中华医学会神经病学分会. 中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014 [J]. 中华神经科杂志, 2015, 48(4): 258-273.
24 高乐才, 吴文元, 魏金栋, 等. 利伐沙班与低分子肝素对髋、膝关节置换术后隐性失血影响的对比观察 [J]. 现代中西医结合杂志, 2013, 22(7): 721-722.
25 顾广飞, 王家骐. 低分子肝素和利伐沙班在髋膝关节置换中的应用 [J]. 国际骨科学杂志, 2010, 31(3): 166-168.
26 袁磊, 包倪荣, 赵建宁. 髋关节置换术后隐性失血的新进展 [J]. 中国骨伤, 2015, 28(4): 378-382.
27 丁水平, 方淑贤. 吲哚布芬治疗血栓性疾病研究进展 [J]. 医药导报, 2006, 25(10): 1039-1041.
28 Tamassia V, Corvi G, Fuccella LM, et al. Indobufen (K 3920), a new inhibitor of platelet aggregation: effect of food on bioavailability, pharmacokinetic and pharmacodynamic study during repeated oral administration to man [J]. Eur J Clin Pharmacol, 1979, 15(5): 329-333.

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更新日期/Last Update: 2019-02-25