低分子肝素联合间歇充气加压预防人工关节置换术后下肢深静脉血栓形成

Low-molecular-weight heparin in combination with intermittent pneumatic compression on prophylaxis of deep venous thrombosis following arthroplasty

目的比较在手术前后不同时间使用低分子肝素(low-molecular-weightheparin,LMWH)联合间歇充气加压装置(intermittentpneumaticcompression,IPC)预防人工关节置换术后下肢深静脉血栓(deepvenousthrombosis,DVT)形成的效果和安全性。方法2003年7月至2005年6月,156例人工关节置换手术病例,随机分成4组。第1组38例,术前使用LMWH、麻醉开始时即使用IPC;第2组42例,术后使用LMWH、麻醉开始时即使用IPC;第3组36例,术前使用LMWH、术后使用IPC;第4组40例,术后使用LMWH与IPC。进行DVT症状评估、下肢深静脉的彩超检查,观察出血并发症与记录围手术期出血量。结果第1组,DVT2例(5.26%),出血量(1030.8±282.0)ml;第2组,DVT2例(4.76%),出血量(900.7±246.9)ml;第3组,DVT1例(2.78%),出血量(1040.3±288.5)ml,1例上消化道出血;第4组,DVT9例(22.5%),出血量(852.2±295.4)ml。在DVT发生率上,第1、2、3组明显低于第4组(P﹤0.05);在围手术期出血量上,第2、4组少于第1、3组(P﹤0.05)。结论术后使用LMWH联合麻醉开始时即使用IPC以预防人工关节置换术后DVT发生的效果好,安全性高。

Objective Examinating the efficacy and safety on prophylaxis of deep venous thrombosis（DVT） following arthroplasty using low-molecular-weight heparin （LMWH） in combination with intermittent pneumatic compression （IPC） starting with different time. Methods 156 patients undergoing primary arthroplasty from July 2003 to June 2005 were divided into four groups randomly. In the first group, 38 patients used LMWH preoperatively and IPC starting since anesthesia. In the second group, 42 patients did LMWH postoperatively and IPC starting since anesthesia. In the third group, 36 patients did preoperative LMWH and post-operative IPC. In the fourth group, 40 patients did post-operative LMWH and IPC. All patients were examined by colour duplex ultrasonography, valued the clinical symptom of DVT, recorded the volume of blood loss in perioperation and observed complication of hemorrhage. Results In the first group, two cases of DVT （5.26%） were found and the average perioperative volume of blood loss was （1030.8± 282.0） ml. In the second group, two cases of DVT （4.76%） were found and the average volume of blood loss was （900.7±246.9） ml. In the third group, one case （2.78%） of DVT was found and the average volume of blood loss was （1040.3±288.5） ml. In the fourth group, nine cases of DVT （22.5%） were found and the average volume of blood loss was （852.2±295.4） ml. Comparing the incidence of DVT between each group, group 1, 2, 3 were lower than group 4（P 〈 0.05）. Comparing the volume of blood loss in perioperation, group 2 , 4 were less than group 1,3 （P 〈 0.05）. Conclusion On the basis of this study, it is more effective and safer using LMWH staring with post-operative 10 h in combination with IPC starting with anesthesia on prophylaxis of DVT following arthroplasty.