低分子肝素联合间歇充气加压预防髋、膝关节手术后静脉血栓栓塞症

Low-molecular-weight heparin in combination with intermittent pneumatic compression on prophylaxis of venous thromboembolism in patients undergoing hip or knee operation

目的探讨低分子肝素(low-molecular-weight heparin,LMWH)联合间歇充气加压(intermittent pneumatic compression,IPC)预防髋、膝关节手术后静脉血栓栓塞症(venous thromboembolism,VTE)的疗效和安全性。方法对53例髋、膝关节手术患者术后使用LMWH联合IPC预防VTE。其中人工全髋关节置换术18例,人工全膝关节表面置换术7例,动力髋螺钉(DHS)内固定术17例,髋臼骨折重建钢板内固定术11例。术后8h给予常规剂量LMWH,以后每24h重复使用一次,直至术后10d。同时术后当天持续使用IPC 8h,第2天起每天分2次使用,每次1h时,疗程10～14d。术后5～7d进行VTE症状评估和下肢静脉的彩超检查,并监测血小板计数及血凝,可疑肺动脉栓塞患者行CT肺动脉造影。术后1～3个月的随访中,对可疑DVT患者行第二次彩超检查。结果 53例髋、膝关节手术患者有4例出现深静脉血栓(deep venous thrombosis,DVT),发生率为7.54%,均在出院后的3个月术后随访期内发生,伴有不同程度的下肢肿胀症状,所有患者均未出现肺栓塞(pulmonary embolism,PE)症状及严重出血并发症。国际标准化比值(international normalizedration,INR)在2.5以内,未引起血小板计数减少。结论联合使用LMWH和IPC可以显著降低髋、膝关节手术后VTE的发生率,并且具有良好的安全性。

Objective To investigate the efficacy and safety on prophylaxis of venous thromboembolism（VTE）in patients undergoing hip or knee operation using low-molecular-weight heparin（LMWH） in combination with intermittent pneumatic compression（IPC）.Methods 53 cases of hip or knee surgery were treated with LMWH and IPC to prevent VTE.Among them,18 cases were received total hip arthroplastics,7 cases were received total knee arthroplastics,17 cases were received dynamic hip screw（DHS）,11 cases of acetabular fracture were received internal fixation with reconstruction plate.Every cases were given LMWH staring with post-operative 8h for 10 days（Once a day） and post-operative IPC for 10 to 14 days.IPC was continuously used for 8h on the day of operation,and used for 2h since second day（1 hour bid）.All patients were evaluated by clinical symptom of VTE,colour duplex ultrasonography and measure of platelet count and blood coagulation were performed within 5 to 7 days after operation to check the presence of DVT.Patients suspected with pulmonary embolism underwent computed tomography pulmonary angiography.Colour duplex ultrasonography were performed again for those suspected with DVT after 1 to 3 months of postoperation follow-up.Results Among the 53 cases,4 DVT cases accompanied by lower limb swelling of varying degrees were found,the incidence was 7.54%.The 4 case were occurred within 3 months of the postoperative follow-up period after discharged from hospital.Pulmonary embolism and serious bleeding complications did not occur in all cases.International normalized ration（INR） did not exceed 2.5 and platelet count has not decreased.Conclusion LMWH in combination with IPC can significantly reduce the incidence of VTE after hip or knee surgery,and has a good security.