全髋关节置换后对深静脉血栓的综合预防

Comprehensive prevention of deep vein thrombosis after total hip replacement

背景:全髋关节置换后深静脉血栓高发,对患者危害很大,因此全髋关节置换后有必要寻找一种安全有效的预防方案来降低深静脉血栓的危害。目的:观察综合预防方案对全髋关节置换后发生深静脉血栓的影响。方法:将102例全髋关节置换患者随机分为观察组和对照组,每组51例。观察组采用综合预防方案,由序贯、交叉的联用低分子肝素、间歇式充气压力治疗及持续股神经阻滞镇痛3个干预措施有机组成;对照组由医生根据临床经验给予低分子肝素抗凝治疗,或者间歇式充气压力治疗。比较两组患者深静脉血栓发生及分布情况,同时统计血小板和血红蛋白情况。结果与结论:观察组患者深静脉血栓阳性数3例,深静脉血栓发生率为6%;而对照组患者深静脉血栓阳性数11例,深静脉血栓的发生率为22%,两组相比差异有显著性意义(P<0.05)。两组发生深静脉血栓患者深静脉血栓在近、远端静脉分布构成比上差异无显著性意义(P>0.05)。两组患者置换后1 d血红蛋白值较置换前降低,差异有显著性意义(P<0.05);两组患者置换后1 d血小板值较置换前有所降低,但差异无显著性意义(P>0.05);两组患者置换后1 d和6 d之间的血红蛋白值及血小板值差异无显著性意义(P>0.05)。提示由序贯、交叉的联用低分子肝素、间歇式充气压力治疗及持续股神经阻滞镇痛3个干预措施组成的综合预防方案可显著降低全髋关节置换后患者深静脉血栓的发生率,且无严重并发症,效果确切可靠。

BACKGROUND： A high incidence of deep vein thrombosis after total hip replacement does great harm to patients, so it is necessary to look for a safe and effective prevention program after total hip replacement to reduce the harm of deep vein thrombosis. OBJECTIVE： To observe the influence of comprehensive prevention scheme on deep vein thrombosis after total hip replacement. METHODS： 102 cases undergoing total hip replacement were randomly divided into observation group and control group with 51 cases in each group. Patients in the observation group received the comprehensive prevention program, which is composed of three interventions： sequential cross combined with low molecular heparin, intermittent pneumatic pressure therapy and continuous femoral nerve block analgesia. In the control group, patients received low-molecular-weight heparin for anticoagulation therapy by the doctor according to his clinical experience, or intermittent pneumatic pressure therapy. The occurrence and distribution of deep vein thrombosis were compared in patients of both groups. At the same time, platelet and hemoglobin were recorded.RESULTS AND CONCLUSION： In the observation group, three patients suffered from deep vein thrombosis with an incidence of 6%. In the control group, 11 patients affected deep vein thrombosis, with an incidence of 22%. There were significant differences between the two groups （P 〈 0.05）. No significant difference in constituent ratio of the distribution of deep vein thrombosis was detected in the distal vein and proximal vein in patients of both groups （P 〉 0.05）. Hemoglobin value was lower at I day after surgery compared with that pre-operation in the two groups （P 〈 0.05）. Platelet value was lower at 1 day after surgery compared with that pre-operation in the two groups （P 〉 0.05）. No significant difference in hemoglobin and platelet values was detected between two groups at 1 and 6 days after surgery （P 〉 0.05）. Results indicated that the comprehensive prevention program containingthe sequential and cross combined with low molecular heparin, intermittent pneumatic pressure therapy and continuous femoral nerve block analgesia can significantly reduce the incidence of deep vein thrombosis, and no serious complications occurred, and the effects are affirmative and reliable.