间歇充气压缩泵与低分子肝素预防急性脊髓损伤下肢深静脉血栓的效果和安全性

Curative effect and safety analysis of intermittent pneumatic compression and low molecular weight heparin in the prevention of deep vein thrombosis of acute spinal cord injury

目的探讨间歇充气压缩泵（IPC）与低分子肝素（LMWH）预防急性脊髓损伤（ASCI）下肢深静脉血栓（DVT）的效果和安全性。方法84例ASCI患者随机分为IPC组、LMWH组、IPC＋LMWH组和对照组，分别给予持续IPC、注射LMWH、二者联合运用和常规护理按摩，观察各组股静脉和胭静脉血流速度；检测部分凝血酶时间（APTT）、活化凝血时间（ACT）和血小板功能（PF）；记录患者发生下肢DVT的例数和时间；并对相关不良事件进行分析。结果对照组中3例患者发生下肢DVT（14．28％），余组患者均未发生下肢DVT（P〈0．05）。IPC可以提高下肢静脉血流速度，对凝血系统和PF无影响，注射LMWH可以延长APTT、ACT并降低PF，单独使用未见并发症发生，二者联用可以观察到双重效果，但也发生1例出血倾向，可能与LMWH导致凝血功能改变有关。结论相对常规护理按摩，其余3组方案预防下肢DVT效果更佳，IPC和LMWH在预防ASCI患者下肢DVT形成的效果相当，但IPC治疗更为安全。

Objective To explore the curative effect and safety analysis of intermittent pneumatic compression （IPC） and low molecular weight heparin （LMWH） in the prevention of acute deep vein thrombosis （DVT） of acute spinal cord injury. Methods 84 cases of patients with acute spinal cord injury were randomly divided into control group（ n = 21 ） , IPC group（ n = 21 ）, LMWH group （n = 21 ） and combined group （ n = 21 ）, and regular care and massage, IPC, subcutaneous injection with LMWH and combined treatment with both IPC and LMWH were given respectively. The blood flow velocity, partial thromboplastin time （ APTT）, activated clotting time （ACT） and platelet function （PF） of femoral vein and popliteal vein were observed and recorded, as well as the time and cases of DVT and adverse event like bleeding or death. Results 3 cases in the control group had DVT （the occurrence rate of 14.28% ）, no cases had DVT in other 3 treatment group （P 〈 0.05 ）. There was no significant difference in preventive effect of 3 treatment group. IPC can increase the blood flow rate without any influences on coagulation system and platelet functions. LMWH injection can delay the APTT and ACT, and reduce PF. There were no complications in either IPC or LMWH group. Double above effect and 1 case of bleeding were observed in the combined treatment group due to the side effect of LMWH. Conclusion Compared with regular care and massage, the other 3 groups have better effect on the prevention of DVT. The effect of IPC and LMWH on preventing DVT is similar in acute spinal injury,but the treatment of IPC is safer.