高海拔地区下肢骨折并发急性深静脉血栓形成的防治

Prevention and treatment of deep venous thrombosis following fracture of lower limb on highland

【目的】探讨高海拔（2100—3800m）地区下肢骨折患者并发急性深静脉血栓形成的防治措施。【方法】回顾分析我院收治的512例下肢骨折患者，分为干预组和对照组，干预组384例在围手术期采取积极的干预措施，而对照组128例给予常规处理，并对85例发生深静脉血栓形成的病人应用活血化瘀、溶栓、抗凝、祛聚、扩血管等综合治疗。【结果】急性下肢深静脉血栓形成的发病率在干预组为12．0％，而对照组为30．5％，两组相比差异有显著性意义（P〈0．01），其中远端血栓23例，近端血栓37例，混合血栓25例，通过综合治疗，疗效优者43例，良37例，差5例，总有效率94．1％，疗效满意。【结论】在高海拔地区，对于易罹患下肢深静脉血栓形成的高危病人，应积极采取预防措施，及时降粘、改善血液高凝状态，早期诊断早期治疗是取得疗效的关键。

[Objective] To explore the prevention and treatment of acute deep venous thrombosis （DVT） following fracture of lower limb in high altitude area （2 100 - 3 800 m）. [Methods] The clinical data of 512 patients with fracture of lower limb from Ju12001 to Dec 2005 were analyzed. 384 cases （treated group） were treated with energetic composite interventional measures, 128 cases （control group） were treated routinely, and 85 patients with acute deep venous thrombosis following fracture of lower limb received the combined therapy, including activating blood circulation to dissipate blood stasis, thrombolysis, antieoagulation, agglutination- relieving and vessels di/atation, etc. [Results] After giving composite interventional measure, the morbidity of DVT in treated group was 12.0%, but thatin control group was 30.5%, difference the was significant （P 〈 0.05）. This data included 23 distal thrombus, 37 proximal thrombus and 25 mixed thrombus. After combined therapy, 43 cases got superior curative effect, 37 cases got favorable curative effect, only 5 cases were ineffective. The total effective rate was 94.1%, curative effect was satisfactory. [Conclusions] In high altitude area, for patients with high risk of getting acute deep venous thrombosis, preventive measure in earlier period, including lowering of blood viscosity and improving blood hypereoagnlabale state are necessary. However, early diagnosis and early treatment is the key to prevent and cure acute thrombosis of deep vein.