周期性充气加压预防髋关节置换术后下肢深静脉血栓的效果

Comparison of intermittent pneumatic compression system with low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement

目的比较观察单纯使用周期性充气加压系统(IPCS)与低分子肝素预防人工全髋关节置换术后下肢深静脉血栓(DVT)的临床效果。方法选取61例单侧初次全髋关节置换术的患者,随机分成IPCS组和低分子肝素组。低分子肝素组从术前第1天开始应用低分子肝素0.2ml/d,皮下注射。IPCS组术后立即使用IPCS治疗,每天5h,术后14d内持续使用。每个研究对象分别于术前1d、术后第3、7d各进行下肢深静脉超声、血浆D-二聚体、P-选择素测定。结果肝素组和IPCS组发生DVT分别为2例和3例;两组均未出现有临床症状的肺栓塞;两组临床效果差异无显著性(P>0.05)。结论下肢IPCS系统对全髋关节置换术后的DVT形成具有很好的预防作用,是一种安全、简便的物理疗法。

Objective To compare the safety and effectiveness of the intermittent pneumatic compression system with those of low-molecular-weight heparin for prevention of deep-vein thrombosis after total hip replacement. Methods 61 patients were performed a randomized trial to evaluate the effectiveness and safety of low-molecular-weight heparin as compared with the intermittent pneumatic compression system to prevent deep-venous thrombosis after total hip replacement. Patients in low-molecular-weight heparin group were given 0. 2 ml subcutaneously daily, and patients in intermittent pneumatic compression group were treated by intermittent pneumatic compression system from 5h after surgery till 14 days after surgery. Quality detect plasma D-dimer and P-selectin and Color Doppler Flow Imaging in two groups were examined on one day before surgery and the third day after surgery and the seventh days after surgery respectively. Results There were 3 patients and 2 patients with deep-vein thrombosis in the intermittent pneumatic compression system group and low-molecular-weight heparin group respectively. No patient developed clinical features of a pulmonary embolism. There were no significant between these two groups （ P 〉 0. 05 ）. Conclusions This study confirms the safety and efficacy of intermittent pneumatic compression system compared with low-molecular-weight heparin and supports the use of mechanical compression for prophylaxis against deep venous thrombosis in patients fol- lowing total hip arthroplasty.