腰椎融合术后药物和物理方案预防静脉血栓栓塞症的效果比较

目的比较利伐沙班与间歇充气加压泵联合弹力袜两种方案预防腰椎融合术后患者静脉血栓栓塞症(VTE)的效果。方法选择2013年1~7月行腰椎融合术后患者203例,随机分为口服利伐沙班预防方案组(A组,101例)和间歇充气加压泵联合弹力袜预防方案组(B组,102例),均于术后7d停止预防措施。分别于术前和术后7d行双下肢血管超声检查及血液检查凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体含量。术后记录48h引流量、90d内VTE发生情况及出血不良反应。结果 A组患者术后90d内均无VTE发生;B组术后7d无VTE发生,术后第13天及第45天分别有1例发生VTE;两组比较差异无统计学意义(P=0.498)。术后7d D-二聚体含量B组是A组的2.2倍,同时两组术后7d D-二聚体含量均比术前高,统计学比较均有显著差异(P0.001)。两组术后48h伤口引流量、术后第7天PT、APTT水平及术后90d内出血不良反应病例比较差异均无统计学意义(P0.05)。结论利伐沙班与间歇充气加压泵联合弹力袜在预防腰椎术后患者静脉血栓栓塞症上效果相当且安全。

A comparative study of the effect of rivaroxaban and physical treatment on prevention of venous thromboembolism after lumbar interbody fusion

Objective To evaluate the preventive effects of rivaroxaban and intermittent pneumatic compression combined with elastic stocking on venous thromboembolism(VTE) after lumbar interbody fusion.Methods Two hun-dred and three patients who underwent lumbar interbody fusion in our departmentl from Jan.2013 to Jul.2013 were involved in the study.Rivaroxaban( group A,101 cases) or intermittent pneumatic compression combined with elas-tic stocking( group B,102 cases) were applied for 7 d after surgery.The color Doppler ultrasound examination of lower extremities,D-dimer,PT and APTT were evaluated before and at 7 d after surgery.Postoperative drainages within 48 h and the VTE and adverse reactions within 90 d postoperatively were also recorded.Results There was no VTE of lower extremity in group A and 2 in group B(13 d and 45 d,respectively) within 90 d postoperatively. However,there was no significant difference between the two groups(P=0.498).The D-dimer value increased in both groups after surgery(P<0.001).The D-dimer in group B was 2.2 times of that in group A at 7 d after surgery.There was no significant difference in drainage volumes,the levels of PT and APTT and the adverse reactions postoperatively between group A and group B(P>0.05).Conclusion Both rivaroxaban and intermittent pneumatic compression combined with elastic stocking are effective and safe for the prevention of VTE after lumbar interbody fusion.