间歇充气加压治疗预防内科重症患者静脉血栓栓塞症

The efficacy of intermittent pneumatic compression in the prevention of venous thromboembolism in medical critically ill patients

目的探讨间歇充气加压治疗（IPC）对内科重症患者静脉血栓栓塞症（VTE）的预防作用。方法采用前瞻性随机对照临床试验，将2008年6月至2010年6月收入重症监护病房（ICU）未接受抗凝治疗的162例重症患者按随机数字表法分配到IPC组和对照组。IPC组从患者人ICU当日直到离开ICU给予IPC预防VTE；对照组不予任何措施预防VTE；以28d为观察期，比较观察期内两组患者VTE[包括深静脉血栓形成（DVT）和肺栓塞（PE）3发生率、机械通气时间、ICU住院时间、非心源性猝死发生率、ICU病死率及IPC预防VTE的不良反应。结果在观察期内，IPC组和对照组DVT发生率分别为3．80％（3／79）和19．28％（16／83），PE发生率分别为0（0／79）和9．64％（8／83），非心源性猝死发生率分别为1．26％（1／79）和7．23％（6／83），两组比较差异均有统计学意义（均P〈0．01）；IPC组机械通气时间（d：8±6比9±8）、ICU住院时间（d：9±7比10±7）、ICU28d病死率（24．05％比31．32％）均低于对照组，但差异无统计学意义（均P〉0．05）。IPC预防VTE过程中没有出现相关不良反应。结论IPC是预防内科重症患者发生VTE的一种安全有效的措施，IPC可以降低内科重症患者非心源性猝死发生率。

Objective To evaluate the efficacy of intermittent pneumatic compression （IPC） in the prevention of venous thromhoembolism （VTE） in medical critically ill patients. Methods A prospective, randomized, controlled study was conducted. One hundred and sixty-two medical critically ill patients were randomly assigned to IPC group and control group by random number table after admitted to intensive care unit （ICU） from June 2008 to June 2010. Patients under anticoagulation medicine therapy were excluded. Patients in the IPC group were treated with IPC to prevent VTE after ICU admission. No measures were taken to prevent VTE in the control group. The rate of VTE [deep vein thrombosis （DVT） and pulmonary embolism （PE）], duration of mechanical ventilation （MV）, the length of stay in ICU, rate of non-sudden cardiac death and ICU mortality rate and related side-effects of IPC were compared during the subsequent 28 days between two groups. Results Compared with control group, IPC group was shown to have a significantly lower rate of DVT [3. 8% （3/79） vs. 19.28% （16/83）, P〈 0. 01], lower rate of PE [0 （0/79） vs. 9± 64% （8/83）, P〈0.01] and lower rate of non-sudden cardiac death [1.26% （1/79） vs. 7.23% （6/83）, P〈0. 013. Compared with control group, duration of MV （days：8±6 vs. 9± 8） and length of stay in ICU （days： 9±7 vs. 10~7） were shorter, and the ICU mortality rate of 28 days （24.05% vs. 31.32 %） was lower in the IPC group, but they were not statistically significant （all P〉0.05）. No related side-effects were found in the IPC group. Conclusion IPC can prevent VTE, and lower the rate of non-sudden cardiac death, and it is safe in medical critically ill patients.