摘要
目的探讨利伐沙班预防脾切除术后门静脉血栓(PVT)形成的作用机制。方法将82例接受脾切除术的患者随机分为利伐沙班组(n=41)和对照组(n=41)。利伐沙班组给予利伐沙班,对照组给予低分子肝素联合华法林。两组患者术后均随访6个月。比较两组的术后PVT发生情况、凝血相关指标、用药安全性及患者耐受性、生存率。结果术后6个月,利伐沙班组的PVT发生率明显低于对照组,差异具有统计学意义(P<0.05)。利伐沙班组的PVT发生率为43.9%,明显低于对照组的80.5%,差异具有统计学意义(P<0.05)。术后1周及1个月,利伐沙班组的凝血酶原时间(PT)长于对照组,蛋白C(PC)和蛋白S(PS)水平均明显高于对照组,差异具有统计学意义(P<0.05)。两组术后6个月内肝功能失代偿及肝癌发生率均无显著差异(P>0.05)。两组患者均对药物耐受,随访6个月内未出现死亡病例。结论预防性使用利伐沙班可显著降低脾切除术后PVT发生率。对患者PC和PS的保护作用可能是利伐沙班预防PVT发生的重要作用机制之一。
Objective To investigate the mechanism of rivaroxaban in preventing portal vein thrombosis(PVT)formation after splenectomy.Methods Eighty-two patients undergoing splenectomy were randomly divided into rivaroxaban group(n=41)and control group(n=41).The rivaroxaban group was given rivaroxaban,and the control group was given low molecular weight heparin combined with warfarin.The patients in both groups were followed up for 6 months.The postoperative PVT occurrence,coagulation-related indicators,drug safety,patient tolerance and survival rate were compared between the two groups.Results At 6 months after operation,the incidence of PVT in the rivaroxaban group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of PVT in the rivaroxaban group was 43.9%,which was significantly lower than 80.5%in the control group,and the difference was statistically significant(P<0.05).At 1 week and 1 month after operation,the prothrombin time(PT)in the rivaroxaban group was longer than that in the control group,the protein C(PC)and protein S(PS)levels were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Within 6 months after operation,there were no significant differences in the incidences of liver function decompensation and liver cancer between the two groups(P>0.05).The patients of both groups were resistant to drugs,and no deaths occurred within 6 months of follow-up.Conclusion Prophylactic use of rivaroxaban can significantly reduce the incidence of PVT after splenectomy.The protective effect on PC and PS may be one of the important mechanisms of rivaroxaban in preventing PVT.
作者
吕远
冯永安
姚伟
张梅
姚英民
吴胜利
LYU Yuan;FENG Yong'an;YAO Wei;ZHANG Mei;YAO Yingmin;WU Shengli(Hepatobiliary Pancreatic Splenic Surgery Department,Affiliated Baoji Hospital of Xi'an Medical University,Baoji 721006;Hepatobiliary Surgery Department,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)
出处
《临床医学研究与实践》
2023年第15期13-16,40,共5页
Clinical Research and Practice
基金
陕西省重点研发计划项目(No.2017SF-195)。
