全髋关节置换术后下肢肿胀与血液流变学的相关性研究

Relativity between lower limb swelling and hemorrheology after total hip arthroplasty

目的 :观察全髋关节置换术 (THA)后下肢肿胀与血液流变学指标的变化及其相关性 ,探讨下肢深静脉血栓形成 (DVT)的危险因素。方法 :对 38例全髋关节置换术患者于术前 1d ,术后 1,3,7d晨测量下肢髌上、髌下、踝上各 10cm周径 ,空腹静脉穿刺采取血样 ,检测血液流变学指标。结果 :术后 1d下肢周径明显增加 (P <0 .0 5 ) ,7d时逐渐缓解与术前无明显差异 (P >0 .0 5 ) ;全血黏度和血浆黏度术后 1d明显下降 (P <0 .0 5 ) ,术后 3、7d逐渐上升超过术前水平 (P <0 .0 5 ) ;红细胞聚集指数 (EAI)术后逐渐增高 ,于 3、7d时明显 (P <0 .0 5 ) ;红细胞变形能力 (TK值 )术后 7d时明显升高 (P <0 .0 5 ) ,表明红细胞变形能力明显下降 ;下肢周径与血液流变学各项参数之间无明显相关性 (P >0 .0 5 )。结论 :THA术后早期下肢肿胀不能作为DVT形成的依据 ,但因下肢肿胀与血液流变学指标有明显改变 ,仍应做好下肢肿胀的观察与护理。

Objective: To detect the risk factors of deep vein thromboses (DVT) after total hip arthroplasty by studying the relationgship of lower limb swelling and hemorheology. Methods: Before operation and 1, 3, 7 days after operation, the circuit length of 10cm up and down petala and 10cm up ankle were measured in 38 cases of THA. At the same time, blood samples were retrieved for rheology evaluation. Results: Lower limb was obviously swelled at the 1 st day after operation ( P <0.05) and decreased at the 7 th day ( P >0.05). Compared with pre-operation, blood viscosity and plasma viscosity were decreased at the 1 st day ( P <0.05),and increased at the 3 rd and 7 th day ( P <0.05) after operation. Erythrocyte aggregate index gradually increased and was significant at the 3 rd and 7 th day after operation. TK value was increased distinctly at the 7 th day post-operation indicated decrease of red blood cell deformation ability. Conclusion:Swelling of lower limb cannot be taken as the proof of DVT after operation. Significant changes of lower limb and hemorheology were seen after THA.