围手术期康复临床路径在防治老年病人髋部骨折全髋关节成形术后静脉血栓栓塞的作用研究

Effect of clinical pathway of rehabilitation in perioperative period on perioperative venous thromboembolism in older patients with THA of hip fractures

目的探讨康复临床路径对于降低围手术期老年病人髋部骨折全髋关节成形术(tatol hip arthroplasty,THA)后静脉血栓栓塞(venous thromboembolism,VTE)的应用价值。方法髋部骨折行THA术的老年病人139例,随机分为常规组和康复临床路径组。常规组75例,接受常规预防下肢血栓的运动治疗[康复临床路径组64例,入院当天即开始进行为期1个月的康复临床路径。疗程结束后比较两组病人D-二聚体水平和全血黏度,并对深静脉血栓形成(deep vein thrombosis,DVT)、肺栓塞(rulmonary Embolism,PE)发病情况、出血情况进行分析。结果治疗后康复临床路径组病人D-二聚体水平、全血黏度分别为(300. 25±90. 28)μg/L和(3. 33±0. 45)m Pa·s,常规组分别为(326. 11±93. 05)μg/L和(4. 42±0. 65) m Pa·s,两组比较差异有统计学意义(P <0. 05)。康复临床路径组病人术后1个月内DVT发生率为10. 9%,常规组为25. 3%,两组比较差异有统计学意义(P <0. 05),两组间PE发生率比较差异无统计学意义(P> 0. 05)。结论围手术期康复临床路径能够有效预防老年病人髋部骨折THA术后1个月内VTE的发生。

Objective The purpose of this study was to examine the effect of clinical pathway of rehabilitation on perioperative VTE in older patients with THA of hip fractures. Methods 139 older patients with THA of hip fractures were randomly divided into the conventional therapy group and the rehabilitation clinical pathway group.Conventional therapy group(n=75)receive conventional exercise therapy to preventing thrombosis.Rehabilitation clinical pathway group(n=64)receive motility rehabilitation therapy on admission.Ddimer level and whole blood viscosity were compared when the treatment is over.Moreover,the risks of bleeding and the morbidity of deep vein thrombosis(DVT)and pulmonary embolism(PE)after surgery were evaluated. Results Compared with conventional therapy group[(326.11±93.05)μg/L and(4.42±0.65)mPa·s],D dimer level[(300.25±90.28)μg/L] and whole blood viscosity[(3.33±0.45)mPa·s] in rehabilitation clinical pathway group were significantly decreased(P<0.05).The incidence of DVT within one month after surgery in the clinical pathway of rehabilitation group was significantly lower(10.9%)than in the conventional group(25.3%)(P<0.05).There was no significant difference in PE incidence between the two groups(P>0.05). Conclusion Clinical pathway of rehabilitation combined with anticoagulant drugs can significantly reduce the risk of VTE with in 1 month after the THA of hip fractures in highrisk population over 65 years of age.