应用气囊止血带对下肢手术患者凝血功能及深静脉血栓形成的影响

Impact of Air Tourniquet on Coagulation Function and Deep Venous Thrombosis After Lower Extremity Surgery

目的探讨应用气囊止血带对下肢手术患者凝血功能及深静脉血栓形成的影响。方法将180例择期进行下肢手术患者随机分为A组(止血带组)、B组(止血带+抗凝组)、C组(非止血带对照组)三组,每组60例,分别检测术前、术后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)水平,并记录术后7 d内深静脉血栓形成的发病率。结果与术前相比,两组患者术后的凝血功能指标PT、APTT、D-D均有不同程度升高或延长,差异有统计学意义(P<0.05);A组术后各指标均显著高于B组、C组,差异有统计学意义(P<0.05)。术后7 d内A、B、C三组的深静脉血栓形成发病率分别为26.67%、8.33%、11.67%,A组的发病率显著高于其他两组(P<0.05)。结论下肢手术应用气囊止血带可加重患者的高凝状态,增加深静脉血栓形成的发病风险,术后加用低分子肝素抗凝可有效降低患者深静脉血栓形成的发病率。

Objective To investigate the impact of air tourniquet on coagulation function and deep venous thrombosis after lower extremity surgery. Methods A total of 180 cases of patients with selective lower extremity surgery were randomly divided into three groups equally： group A underwent the operation with an air tourniquet, group B underwent the operation with an air tourniquet and received routine treatment with lowmolecular weight heparin（LMWH）, and group Cunderwent the operation without an air tourniquet. Prothrombin time（PT）, activated partial thromboplastin time（APTT）, D-D imer（D-D） were measured before and after surgery. The incidence of deep venous thrombosis（DVT） within 7 days after surgery was compared among three groups. Results The levels of PT, A PTTand D-D after surgery in each groups were significantly higher than those before surgery（P〈0.05）, and the levels of PT, A PTTand D-D in group A were significantly higher than those in group B and group C（P〈0.05）. The incidences of D V Twithin 7 days after surgery were 26.67%, 8.33% and 1 1.67% of group A, group B and group C, respectively; The incidence of DV Tin group A was significantly higher than those in the other groups（P〈0.05）.Conclusions The use of air tourniquet in the lower extremity surgery may aggravate patients＇ hypercoagulability and increase the risk of DVT. R eceiving routine treatment with L MW H may reduce the incidence of DVT.