全髋关节置换术后股深静脉血栓形成与防治

Deep Venous Thrombosis and its Prevention After Total hip Replacement

目的探析全髋关节置换术后股深静脉血栓形成的原因及有效防治措施。方法选择我院2012年1月~2015年6月期间所收治91例拟行全髋关节置换术患者作为研究对象,随机分为A组（n=46）与B组（n=45）。两组均行全髋关节置换术,B组通过主动活动下肢踝、膝、髋关节的方式对下肢静脉血栓进行预防,A组同时结合物理预防（使用间歇充气加压装置IPC）及药物预防（术后12 h开始皮下注射低相对分子质量肝素）。比较两组术前、术后8 h时的D二聚体、血小板计数等血栓指标;记录两组术后股深静脉血栓发生率与全身并发症发生率并比较。结果两组术前D二聚体、血小板计数的差异无统计学意义（P〉0.05）,术后12 h两组D二聚体均降低、血小板计数均升高,与术前相比差异均有统计学意义（P〈0.05）,同时A组术后12 h的D二聚体低于B组、血小板计数高于B组,组间差异有统计学意义（P〈0.05）,提示A组指标改善幅度更大。A组股深静脉血栓发生率为8.7%（4/46）,B组为24.2%（11/45）,A组更低,差异有统计学意义（P〈0.05）;A组术后全身并发症发生率为6.5%（3/46）,B组为20.2%（10/45）,A组更低,差异有统计学意义（P〈0.05）。结论股深静脉血栓形成为全髋关节置换术患者术后常见并发症,形成原因与创伤、反复穿刺、长时间处于被动体位、下肢过度旋转牵引等,此外,手术、麻醉、镇静与肌松药物的应用等多种因素有关,临床可采取同时联合肢体主被动活动、药物预防及物理预防的方式减少全髋关节置换术后股深静脉血栓形成。

Objective To explore the causes and effective prevention and treatment measures of deep venous thrombosis after total hip replacement. Methods 91 patients undergoing total hip replacement in our hospital from January 2012 to June 2015 were selected as the research objects and were randomly divided into group A（ n = 46） and group B（ n = 45）. The two groups were treated with total hip replacement. Group B prevented lower extremity vein thrombosis by actively move ankle,knee and hip joint of lower extremity. Group A was treated with combination of physical prevention（ using intermittent pneumatic compression device IPC） and drug prevention（ 12 h after operation,treated with subcutaneous injection of low molecular weight heparin）.The D-dimer,platelet count and other thrombus indexes were compared between the two groups in 8 h before and after operation; The incidence rates of postoperative deep venous thrombosis and systemic complications in the two groups were recorded and compared. Results There were no statistically significant differences in preoperative D-dimer and platelet count between the two groups（ P〉0. 05）. 12 h after operation,D-dimer and platelet count of the two groups increased. Compared with those before operation,the differences were statistically significant（ P〈0. 05）. Meanwhile,D-dimer of group A in 12 h after operation was lower than that of group B,while platelet count was higher than that of group B（ P〈0. 05）,which indicated that the improvement of indexes in group A was more significant. The incidence of deep venous thrombosis in group A 8. 7%（ 4 /46） was lower than that in group B 24. 2%（ 11 /45）（ P〈0. 05）; The incidence of postoperative systemic complications in group A 6. 5%（ 3 /46） was lower than that in group B 20. 2%（ 10 /45）（ P〈0. 05）. Conclusion Deep venous thrombosis of femoral vein is a common complication in patients with total hip replacement. The cause is related to trauma,repeated puncture,long time in passive position and over rotation and traction of lower limbs,etc. In addition,it is related to the application of surgery,anesthesia,sedation and muscle relaxation drugs and other factors. In clinic,the combination of active-passive activities of limbs,drug prevention and physical prevention can be used to reduce deep venous thrombosis after total hip replacementl.