阿司匹林预防膝关节置换术后下肢深静脉血栓的疗效和安全性(1)
摘要：目的 比较阿司匹林和低分子肝素预防全膝关节置换术(total knee arthroplasty，TKA)后下肢深静脉血栓形成(deep vein thrombosis，DVT)的疗效和安全性。方法 对2015年2月～2015年8月于北京积水潭医院矫形骨科初次行单侧TKA的120例骨关节炎患者随机分为两组，术后12 h，阿司匹林组给予口服阿司匹林(拜阿司匹林)150 mg/d，低分子肝素组给予皮下注射低分子肝素钠(齐征)2500 AxaIU(0.2 ml)/d，两组均应用14 d。對两组DVT发生率、显性及隐性失血量、血红蛋白下降量、血肿发生率及感染发生率进行比较，评价阿司匹林预防TKA术后DVT的疗效及安全性。结果 阿司匹林组，出现有症状性DVT 4例(6.7%)，低分子肝素组术后出现有症状性DVT 3例(5.0%)，两组均未出现疑似或者确诊的肺栓塞。两组比较无统计学意义(P值为0.136)。阿司匹林组出血量、血红蛋白下降量、血肿发生率、感染发生率为(331.2±41.5)ml、(19.2±6.0)g/L、1例(1.6%)、0例(0%)，低分子肝素组为(452.1±53.3)ml、(29.2±8.6)g/L、3例(5.0%)、1例(0.17%)，两组之间无统计学差异(P值分别是0.226、0.421、0.325、0.268)。结论 阿司匹林与低分子肝素相比抗凝效果和术后失血量及出血并发症无差异，但阿司匹林药剂制备成熟，服用方便，价格便宜，对栓塞性疾病的预防作用具有一定优势，可作为全膝关节置换术后多模式抗凝治疗的一部分，安全有效。
, 百拇医药
关键词：关节成形术；膝关节；下肢深静脉血栓形式；阿司匹林
Efficacy and Safety of Aspirin in Prevention of DVT of Lower Limbs after Total Knee Arthroplsaty
LIU Ze-peng1，RONG Shao-yuan1，LI Chun-hong1，LI Jian-hua1，LI Yu-jun2
(1.Department of Orthopaedics，Changping District Hospital，Beijing 102200，China；2.Department of Orthopaedics，Beijing Jishuitan Hospital，Beijing 100035，China)
Abstract：Objective To compare the efficacy and safety of aspirin in prophylaxis of deep venous thrombosis of lower limbs after total knee arthroplasty. Methods From February 2015 to August 2015，120 patients met with our inclusion criteria.All the patients were divided into 2 groups randomly. One group received aspirin enteric-coated tablets 150mg/day since the first day after operation till discharge14 days， and other group received subcutaneous injection of low molecular weight heparin (LMWH) with 2500 Axa IU once daily for 14 days. Estimate the efficacy and safety of aspirin in prevention of DVT of lower limbs after total knee arthroplsaty. Results 4 patients (6.7%) were diagnosed with deep venous thrombosis in group Aspirin. In group LMWH ，3patients (5.0%)had DVT. There were no symptomatic and suspicious pulmonary embolism in two groups. There were no statistic significances between the two groups in all these aspects，such as the quantity of bleeding、decrease of hemoglobin、hematoma rate and infection rate. Conclusion Contrast Aspirin and LMWH， there is no difference in venous thromboemlolism prophylaxis、blood lost and hemorrhage complication postoperation. But Aspirin is cheap， drug-nature stable， administered orally， well tolerated， as a partion of multimodality anticoagulant therapy after total knee arthroplasty.
, 百拇医药
Key words：Arthroplasty；Knee joint；Venous thrombosis；Aspirin
人工全膝关节置换(total knee arthroplasty，TKA)可有效治疗类风湿性关节炎、骨关节炎等导致的严重膝关节疼痛、畸形和活动受限，恢复关节功能，重建无痛、稳定的膝关节，提高患者生活质量。已经成为一种规范化的成熟手术，但患者术后发生静脉血栓栓塞性疾病(VTE)的几率仍然很高，包括下肢深静脉血栓形成(DVT)和肺栓塞(PE)，术后在没有有效预防的情况下，全髋、膝关节置换术后VTE发生率可超过35%，尽管大多数患者没有症状[1]，迄今为止，国内外对全关节置换术后药物预防的种类、方法、安全性和有效性，仍无定论。本研究拟通过观察阿司匹林和低分子肝素的临床应用，比较其预防效果，并对其安全性进行评价，探讨阿司匹林对于预防下肢深静脉的价值。现报告如下。, http://www.100md.com(刘泽朋 荣绍远 李春洪 李建华 李玉军)
, 百拇医药
关键词：关节成形术；膝关节；下肢深静脉血栓形式；阿司匹林
Efficacy and Safety of Aspirin in Prevention of DVT of Lower Limbs after Total Knee Arthroplsaty
LIU Ze-peng1，RONG Shao-yuan1，LI Chun-hong1，LI Jian-hua1，LI Yu-jun2
(1.Department of Orthopaedics，Changping District Hospital，Beijing 102200，China；2.Department of Orthopaedics，Beijing Jishuitan Hospital，Beijing 100035，China)
Abstract：Objective To compare the efficacy and safety of aspirin in prophylaxis of deep venous thrombosis of lower limbs after total knee arthroplasty. Methods From February 2015 to August 2015，120 patients met with our inclusion criteria.All the patients were divided into 2 groups randomly. One group received aspirin enteric-coated tablets 150mg/day since the first day after operation till discharge14 days， and other group received subcutaneous injection of low molecular weight heparin (LMWH) with 2500 Axa IU once daily for 14 days. Estimate the efficacy and safety of aspirin in prevention of DVT of lower limbs after total knee arthroplsaty. Results 4 patients (6.7%) were diagnosed with deep venous thrombosis in group Aspirin. In group LMWH ，3patients (5.0%)had DVT. There were no symptomatic and suspicious pulmonary embolism in two groups. There were no statistic significances between the two groups in all these aspects，such as the quantity of bleeding、decrease of hemoglobin、hematoma rate and infection rate. Conclusion Contrast Aspirin and LMWH， there is no difference in venous thromboemlolism prophylaxis、blood lost and hemorrhage complication postoperation. But Aspirin is cheap， drug-nature stable， administered orally， well tolerated， as a partion of multimodality anticoagulant therapy after total knee arthroplasty.
, 百拇医药
Key words：Arthroplasty；Knee joint；Venous thrombosis；Aspirin
人工全膝关节置换(total knee arthroplasty，TKA)可有效治疗类风湿性关节炎、骨关节炎等导致的严重膝关节疼痛、畸形和活动受限，恢复关节功能，重建无痛、稳定的膝关节，提高患者生活质量。已经成为一种规范化的成熟手术，但患者术后发生静脉血栓栓塞性疾病(VTE)的几率仍然很高，包括下肢深静脉血栓形成(DVT)和肺栓塞(PE)，术后在没有有效预防的情况下，全髋、膝关节置换术后VTE发生率可超过35%，尽管大多数患者没有症状[1]，迄今为止，国内外对全关节置换术后药物预防的种类、方法、安全性和有效性，仍无定论。本研究拟通过观察阿司匹林和低分子肝素的临床应用，比较其预防效果，并对其安全性进行评价，探讨阿司匹林对于预防下肢深静脉的价值。现报告如下。, http://www.100md.com(刘泽朋 荣绍远 李春洪 李建华 李玉军)
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