弹力绷带加压包扎联合低分子肝素对全髋关节置换患者下肢深静脉血栓的影响

Effect of elastic bandage in association with low molecular weight heparin on deep venous thrombosis after total hip arthroplasty

目的 探讨弹力绷带下肢加压包扎联合低分子肝素（Low molecular weight heparin,LMWH）预防全髋关节置换（Total hip arthroplasty,THA）患者下肢深静脉血栓（Deep venous thrombosis,DVT）的临床效果。方法 回归分析2014年1月-2015年10月初次行全髋关节置换病例120例,所有患者皆使用低分子肝素抗凝以预防血栓形成,根据术后下肢是否采用弹力绷带加压包扎分为观察组和对照组。记录并观察术前血小板（Platelet,PLT）、活化部分凝血活酶时间（Activated partial thromboplastin time,APTT）、凝血酶原时间（Prothrombin time,PT）、甘油三酯（Triglyceride,TG）、纤维蛋白原（Fibrinogen,FIB）、总胆固醇（Cholesterol,CHOL）、手术时间及术后引流量;采用彩色多普勒检查评估深静脉血栓形成情况。结果 两组患者基线特征一致,具有可比性。术前两组PLT、APTT、PT、TG、FIB、CHOL及手术时间比较,差异无显著性意义（〉0.05）。观察组术后引流量高于对照组,但两组比较,差异无显著性意义（〉0.05）。术后深静脉血栓形成观察组少于对照组,但两组经卡方检验,差异无显著性意义（〉0.05）。结论 弹力绷带下肢加压包扎联合低分子肝素预防THA术后深静脉血栓形成与单独使用低分子肝素比较无明显统计学差异,其是否能够明显减少DVT数量尚需扩大样本量进行深入研究。

Objective To explore the clinical impact of elastic bandage in association with low molecular weight heparin on deep venous thrombosis after total hip arthroplasty. Methods Between Jan 2014 and Oct 2015, the clinical data from 120 patients undergoing primary total hip arthroplasty were retrospectively analyzed. All patients were given low molecular weight heparin in order to prevent deep venous thrombosis. In accordance with using elastic bandage or not, the cases were divided into two groups, the observation group and the control group. The preoperative PLT, APTT, PT, TG, FIB, CHOL, operation time and postoperative drainage flow of two groups were compared. The Color Doppler was used to detect deep venous thrombosis. Results The characteristics of base line were consistent between the two groups. There was no significant difference in preoperative PLT, APTT, PT, TG, FIB, CHOL, operation time, postoperative drainage flow and deep venous thrombosis between two groups （P〉0.05） ,while the deep venous thrombosis of observation group was lower than those of the control group. Conclusion The addition of elastic bandage did not appear to improve the effectiveness of prophylactic anticoagulation with low molecular weight heparin.