骨科手术后下肢深静脉血栓的早期诊断与预防性治疗

EARLY DIAGNOSIS AND PROPHYLACTIC TREATMENT OFDEEP VENOUS THROMBOSIS OF LOWER LIMBS AFTER ORTHOPEDIC OPERATION

目的:评价对具有下肢深静脉血栓形成(DVT)的高危因素患者进行恰当的预防性治疗的临床意义。方法:选择我科2000年1月～2004年9月下肢手术病人280例(256位病人)进行回顾性分析。病人随机分为两组,其中围手术期进行综合性预防性治疗组156例,对照组124例只给以右旋糖酐40500mL加复方丹参16mL静脉滴注,每天1次,共7d。两组术后处理相同。记录切口引流量,术后第7天多普勒(Doppler)超声筛查,并对结果进行χ2检验。结果:试验组DVT发生率为5.1%,对照组DVT发生率为39.4%,两组差异有显著性意义(P<0.01)。试验组未发现术后出血增多现象以及由此引发的不良反应。结论:围手术期综合性预防下肢深静脉血栓形成能够有效防止肺栓塞及下肢深静脉血栓形成后综合征,且低分子肝素具有良好安全性。

Objective： To estimate the clinical significance of prophylactic treatment for the patients with high risk of deep venous thrombosis in lower limb after orthopedic operation. Methods： 280 cases （256 patients） with lower limb diseases were chosen to be analyzed retrospectively in our department from January 2000 to September 2004. The patients were divided into two group randomly： 156 cases were in prophylactic treatment group;124 cases were in control group only giving intravenous drip of Dextran 40 500 mL and Danshen Root 16 mL for 7 days （once a day）. The treatment on the two groups was the same after operation. The quantity of draining from wound was recorded, screen was done by Doppler 7 days later and the data analyzed by X^2 test. Result： Incidence rate of DVT in prophylactic treatment group was 5.1% compared with control group（39.4 %）, the difference was significance （P〈0.01）. More hemorrhage and adverse effect didn＇t happen in prophylactic treatment group. Conclusion： Comprehensiveness precaution of deep venous thrombosis in lower limbs around operation stage can decrease pulmonary embolism and syndrome of deep venous thrombosis effectively. Low molecular heparin possesses good security.