超早期间歇充气加压预防全膝关节置换术后下肢深静脉血栓形成

To Prevent Deep Venous Thrombosis after Total Joint Arthroplasty with Ultra-early Intermittent Pneumatic Compression

目的:分析比较术前超早期使用间歇充气加压(intermittent pneumatic compression,IPC)装置与术后开始使用IPC预防全膝关节置换术后下肢深静脉血栓形成效果差异。方法:78例TKA患者术前随机分为超早期组和术后组,超早期组术前3d开始使用IPC,术后组术后开始使用IPC。在患者术后3d、7d、14d检查血清D-二聚体(D-D)浓度。术后第3天、14天通过双下肢超声及足背静脉造影检查2组患者DVT发生情况,记录肺动脉栓塞的发生情况。结果:早期组36例患者入院时血清D-D浓度为86.97±34.22μg/mL,经3d的IPC使用之后升高到106.19±38.09μg/mL,差异具有统计学意义(P<0.05);2组患者围手术期出血量比较差异无统计学意义;早期组术后第3天、7天血清D-D浓度比术后组低,差异有统计学意义,术后第14天,2组血清D-D浓度比较差异无统计学意义;2组患者术后第3天DVT发生率无统计学意义,术后第14天发生率比较差异有统计学意义(P<0.05);结论:与术后开始使用IPC相比,术前即开始使用IPC在不增加全膝关节置换手术围手术期出血的情况下可降低患者术后血清D-D浓度水平,并显著降低DVT的发生率。

Objective：To compare the incidence of deep venous thrombosis after total knee replacement between the groups who uses the intermittent pneumatic compression（intermittent pneumatic compression,IPC） in ultra-early and the group who start to use the IPC after surgery.Methods：All of 78 patients performed with TKA were randomly divided into ultra-early group and postoperative group.The IPC were used 3 days before surgery in super-early group,the IPC were used after surgery in postoperative group.The serum D-dimer concentrations（DD） were examinated in the 3rd,7th,14th day after operation.The occurrences of DVT in the two groups were assessed by the dorsal vein of foot angiography and lower extremity ultrasound in the 3rd,14th day after operation;the incidence of pulmonary embolism was also recorded.Results：The serum concentration in all of 36 patients in ultra-early group were increased from 86.97±34.22μg/ml to 106.19 ± 38.09μg/ml,after using IPC for 3 days,and there was significant difference in the data（t=2.252,P=0.027）;there was no significant difference in the perioperative bleeding in two groups.The serum D-dimer concentrations were lower than that in postoperative group,at the 3rd day,7th day respectively,and it has statistical difference.There was no significant difference in the level of serum concentration of DD,at the 14th day.There was also no significant difference in the incidence of DVT,at the 3rd day;but There was significant difference in the incidence of DVT（P=0.046）,at the 14th day,after operation.Conclusions：Using the IPC preoperatively can not increasing the perioperative bleeding,but can lower the levels of serum DD and significantly reduce the incidence of DVT,compared with patients start to use IPC after surgery.