医用弹力袜和间歇充气装置预防妇科恶性肿瘤术后下肢深静脉血栓形成的研究

ES plus IPC treatment in the prevention of postoperative deep vein thrombosis after operation about malignant tumor in gynecology

目的评价医用弹力袜（ES）或与间歇充气装置（IPC）联合使用预防妇科恶性肿瘤术后下肢深静脉血栓（DVT）形成的疗效和安全性。方法将405例妇科恶性肿瘤手术患者，随机分为肝素组、单纯ES组、ES＋IPC组，每组135例。对照组术后仅使用低分子肝素抗凝治疗，单纯ES组使用医用弹力袜进行下肢局部加压，ES＋IPC组将间歇充气装置套于医用弹力袜外间歇性加压下肢。所有患者在术后3—7d内每天进行双下肢深静脉血管彩色多普勒超声检查，比较三组下肢深静脉血栓形成率、术后出现下肢深静脉血栓所需时间及术后测凝血酶原时间（PT）、部分凝血活酶时间（APTT）、组织型纤溶酶原激活剂物抗原（tPA-Ag）。结果术后血管彩超检查显示，下肢深静脉血栓发生率ES＋IPC组为4．4％，低于肝素组和单纯ES组（P〈0．01）；ES＋IPC组形成下肢深静脉血栓的平均时间（6．5±0．6）d，长于其他2组（P〈0．01）。凝血／纤溶指标检测显示肝素组术后6h和术后24hVI＇高于术前，术后6h和术后24h高于单纯ES组和ES＋IPC组（P〈0．05）；ES＋IPC组术后6htPA—Ag高于其他两组（P〈0．05）。结论ES与IPC联合使用能降低妇科恶性肿瘤患者术后DVT发生率，延缓DVT的发生。

Objective To evaluate the efficacy and safety of ES and IPC treatment for prevention deep vein thrombosis in postoperative patients suffered from malignant tumor in gynecology. Methods In this study, 405 patients undergoing survey suffered from malignant tumor in gynecology were randomly divided into three groups：the heparin group, the single ES group and the ES plus IPC group. The heparin group was treated with low molecular weight heparin, the single ES group was treated with graduated elastic stocking and the ES plus IPC group was treated with graduated elastic stocking connected with IPC. Color doppler examination was performed everyday from 3 - 7 th day after operation, the average time was calculated in each group once DVT was identified by color doppler examination ,while blood examination of PT, APTI＂ and tPA-Ag was also done at third day after operation. Results The deep vein thrombosis rate in ES plus IPC group （ 4. 4% ） was significantly lower than those of the the heparin group （ 12.6% ） and the single ES group （ 11.1% ） （ P 〈 0. 01 ）. The average time of appearing DVT in ES plus IPC group （ 6.5- 0.6 ） d was significantly longer than those in heparin group （ 3.9 ± 0.6 ） and single ES group （4.2 ± 0.6 ） d （ P 〈 0. 01 ）. PT in heparin group was longer than that in single ES group and ES plus IPC group（P 〈0. 01 ）, meanwhile tPA-Ag in ES plus IPC group was lower than that of heparin group and single ES group in 6th after operation （P 〈 0. 01 ）. Conclusions ES plus IPC treatment is a safe and effective method for the prevention of postoperative deep vein thrombosis after operation about malignant tumor in gynecology.