综合干预中老年髋膝关节置换术后下肢深静脉血栓形成效果

The effect of comprehensive intervention on elderly arthroplasty and knee arthroplasty patient with lower limbs deep vein thrombosis

目的：探讨综合干预在预防关节置换术后下肢深静脉血栓形成的效果。方法将2015年1月~2015年10月在本院进行髋膝关节置换术的120例患者随机分为干预组和对照组，对照组接受预防DVT的常规护理；干预组患者采取基于DVT预防指南综合干预措施，主要包括健康教育、早期功能锻炼、梯度压力弹力袜或间歇充气加压装置、药物预防等四项，分别观察记录两组患者术前及术后7 d内下肢深静脉血栓（DVT）的相关症状，以及检测术前及术后第5~7天血浆D－二聚体水平和彩色多普勒超声检查。结果术前及术后7d干预组患者Homan征阳性率为5%，Nenhof征阳性率10%，显著低于对照组的46.67%及81.67%，术后第5~7d干预组血浆D-二聚体水平显著低于对照组；干预组60例患者中，58例患者血流通畅，2例患者发生血流淤滞，但无1例发生下肢深静脉血栓，显著低于文献报道的DVT发生率；对照组中9例患者血流通畅，28例血流淤滞，23例发生DVT，干预组与对照组超声结果具有显著差异。结论基于DVT预防指南的综合干预措施能有效地减轻关节置换患者术后DVT的相关症状以及降低DVT的发生风险。

Objective：To study the effect of comprehensive intervention on prevention of deep venous thrombosis（DVT） in patients undergoing total hip arthroplasty（THA）and total knee arthroplasty（TKA）.Methods： 120 patients from January 2014 to January 2015 in our hospital undergoing THA or TKA were randomly divided into intervention group and control group. The patients in the control group received routine nursing care.In addition,the patients in the intervention group received comprehensive intervention measures,which include health education,early exercises after total joint replacement,graduated compression stockings or intermittent pneumatic compression and pharmacological prophylaxis, respectively observe and record the patients preoperative and postoperative 7 d symptoms of deep venous thrombosis and detect preoperative and postoperative 5 ~ 7 days plasma D - dimer level and do the color doppler ultrasound.Result：Preoperative and postoperative 7 d intervention group patients Homan positive rate is 5%,Nenhof positive rate is 10%, signiifcantly lower than the control group;5~7d after intervention group plasma D - dimer level was signiifcantly lower than the control group;There were 58 cases with venous blood lfowing good,2 cases with venous blood sluggish, no 1 cases of lower extremity deep vein thrombosis in intervention group. There were 9 cases with venous blood lfowing good,28 cases with venous blood sluggish, 23 cases of lower extremity deep vein thrombosis in controlgroup.Conclusions：Comprehensive intervention can effectively decrease symptoms of DVT and reduce the risk of DVT undergoing total joint replacement.