下肢骨折深静脉血栓防治的研究进展

Research Progress in the Prevention and Treatment of Deep Venous Thrombosis in Lower Limb Fracture

深静脉血栓形成(deep vein thrombosis,DVT)是下肢骨折术后的常见并发症,具有高发病率、高致残率、高死亡率等特点。目前临床上防治下肢骨折术后深静脉血栓的措施主要包括围手术期护理、医疗辅助器械干预、西药干预、中医干预、患者自身配合等。患者自身配合是一切防治方法顺利实施的基础,患者的积极合作是实现防治作用的前提。围手术期护理有助于患者了解术后DVT的危险因素及DVT发生后可能引起的危险性,指导患者饮食的选择,协助患者术后活动,进而改善患者血液流变学指标水平,减少术后DVT的发生。医疗器械可协助患者进行术后康复锻炼,改善血液动力学水平,促进患者康复及减少术后DVT的发生。西药如低分子肝素、利伐沙班、依诺肝素等抗凝药物可降低凝血因子的聚集及血液黏稠度,减少术后DVT的发生。中医干预主要包括中药内服及外治法如针灸、推拿等。中药内服可改善血流状态;针灸、推拿可调动脏腑功能,激发机体的正气而改善机体气血情况。各项防治措施都有其优缺点,临证运用时需结合具体条件及患者个体状况而选择合理的防治方式。中医干预DVT可在下肢骨折患者的术前及术后执行,且具有费用低、效果确切等特点,值得不断挖掘及传承创新。

Deep vein thrombosis(DVT)is a common complication after surgery for lower limb fracture.It has the features of high morbidity,high disability rate and high mortality.At present,the measures for clinical prevention and treatment of post-operative DVT in lower limb fracture mainly include perioperative nursing,intervention with medical auxiliary instruments,western medicine prevention and treatment,traditional Chinese medicine(TCM)intervention,and patients'self-cooperation.The patients'self-cooperation is the basis for the smooth implementation of other measures for prevention and treatment,and the patients'active cooperation is the premise of achieving the efficacy of prevention and treatment.Perioperative nursing is helpful for the patients to understand the risk factors of postoperative DVT and the possible risks after the occurrence of DVT,guides the patients to choose the food,assists the patients to do postoperative exercises,improves the level of patients'hemorheological indexes,and reduce the incidence of postoperative DVT.Medical devices are helpful for assisting patients to do postoperative rehabilitation exercises,improving the levels of hemodynamic indicators,promoting patients'rehabilitation and reducing the incidence of postoperative DVT.Western medicines such as low molecular weight heparin,Rivaroxaban,Enoxaparin and other anticoagulant drugs can reduce the aggregation of coagulation factors and blood viscosity,and reduce the incidence of postoperative DVT.TCM interventions mainly include oral administration of Chinese medicine and external treatment such as acupuncture,moxibustion and massage.Oral administration of Chinese medicine is helpful for improving blood flow status.Acupuncture,moxibustion and massage are beneficial to the activation of the function of zang-fu organs,and can stimulate the healthy qi to improve the qi-blood state of the whole body.Each method of prevention and treatment has its advantages and disadvantages.In clinical application,reasonable prevention and treatment methods should be selected according to the specific conditions and individual conditions of the patients.TCM intervention of DVT can be performed in patients with lower limb fracture before and after surgery,and has the advantages of low cost and definite efficacy,which is worthy of continuous research and inheritance and innovation.