机械预防和药物预防创伤后深静脉血栓形成的临床观察

Clinical observation on the efficacy of mechanical and pharmacological prophylaxis against deep venous thrombosis following blunt trauma

目的:探讨机械预防、药物预防和机械、药物联合预防钝性创伤后深静脉血栓(Deep venous thrombosis,DVT)和肺栓塞(Pulmonary embolism,PE)的有效性。方法:选择2008年4月至2010年3月收治的329例钝性骨与关节创伤患者,随机分为3组。第1组98例为低分子肝素(Low-molecular-weight-heparin,LMWH)组,在钝性创伤后24～48 h内使用LMWH(40 mg)皮下注射,每天1次。第2组107例为间歇充气加压装置(Intermittent pneumatic compression,IPC)组,入院后即使用抗深静脉血栓的IPC,要求患者每天使用6 h以上。第3组102例为药物联合机械性预防组,在入院后即使用IPC并延迟使用LMWH。进行DVT、PE的症状评估、下肢深静脉的彩超检查,并以逆行足背静脉造影确诊DVT,怀疑有PE时则在24 h内完成螺旋CT肺动脉造影。结果:共307例患者完成研究。第1组,DVT 11例(11.22%),PE 3例(3.1%),发生双下肢大的或阻塞性凝块8例;第2组,DVT 27例(25.2%),PE 14例(13.1%),发生大的或阻塞性凝块11例;第3组,DVT 8例(7.8%),PE 2例(2.0%),发生大的或阻塞性凝块1例。在DVT及PE发生率上,第1、3组明显低于第2组(P<0.05);在大的或阻塞性凝块发生率上,第3组少于第1、2组。结论:严重钝性骨与关节创伤后,早期使用IPC并在出血控制后延迟使用LMWH的方法对预防深静脉血栓有一定的临床疗效,且能比较明显的降低大的或阻塞性凝块的发生率。

Objective：To investigate the efficacy of mechanical and pharmacological prophylaxis against deep venous thrombosis（DVT） and pulmonary embolism（PE） following blunt trauma.Low-molecular-weight-heparin（LMWH）,intermittent pneumatic compression（IPC）,and LMWH combined with IPC were used.Methods：Totally 329 patients with blunt fractures and joint injuries from April 2008 to March 2010 were divided into 3 groups randomly.In group 1,98 patients received LMWH injection in 24~48 h after the blunt trauma,once a day.In group 2,107 patients received IPC since hospitalization for 6 h every day.In group 3,102 patients received IPC after hospitalization and retarded LMWH as well.All the patients were evaluated for the clinical symptoms of DVT and PE,examined by colour duplex ultrasonography,and the patients with suspected PE completed the spiral CT pulmonary angiography in 24 h.Results：In group 1,11 cases of DVT（11.22%）,3 cases of PE（3.1%）,and 8 cases of big or blocking coagulum（8.2%） were found.In group 2,27 cases of DVT（25.2%）,14 cases of PE（13.1%）,and 11 cases of big or blocking coagulum（10.3%） were found.In group 3,8 cases of DVT（7.8%）,2 cases of PE（2.0%）,and 1 case of big or the blocking coagulum（1%） were found.The incidences of DVT and PE in group 1 and 3 were lower than those in group 2（P 0.05）.The incidence of big or blocking coagulum in group 3 was lower than those in group 1 and 2（P 0.05）.Conclusion： After the serious blunt fractures and joint injuries,the early use of IPC and retarded use of LMWH for prophylaxis against deep venous thrombosis following blunt trauma is effective,which also can remarkably reduce the incidence of big or blocking coagulum.