髋膝关节置换术后预防下肢深静脉血栓形成的方法及其效果与安全性

Effectiveness of Low-molecular-weight heparin in combination with intermittent pneumatic compression against deep venous thrombosis following arthroplasty

目的探讨间歇充气加压装置(intermittent pneumatic compression,IPC)联合低分子肝素(Low molecular weight heparin,LMWH)抗凝治疗预防膝、髋关节置换术后下肢深静脉血栓(deep venous thrombosis,DVT)的效果和安全性。方法选取2015-01至2016-01于我科收治的膝髋关节置换患者80例,随机分为两组,一组单独使用LMWH抗凝治疗,另一组采用LMWH联合IPC预防下肢深静脉血栓形成。定期复查下肢静脉超声,可疑肺栓塞(pulmonary embolism,PE)患者行CT肺血管造影检查(computer tomography pulmonary angiography,CTPA)以明确诊断,监测血小板计数和凝血指标。所有患者出院后3个月内均进行随访,统计DVT发生率。结果LMWH联合IPC抗凝组术后DVT发生率明显低于单独使用LMWH组(P<0.05),术后随访所有患者均未出现PE。所有患者INR均在2.5以内,血小板计数未减少。结论 IPC联合LMWH抗凝治疗与单纯应用LMWH抗凝治疗相比能够明显降低膝、髋置换术后早期下肢DVT的发生率,且具有良好的安全性。

Objective To investigate the effectiveness of intermittent pneumatic compression （IPC） device combined with low molecular weight heparin （LMWH） for the prevention of deep venous thrombosis（DVT） after joint replacement surgery. Methods 80 cases with hip or knee joint peripheral fractures and artificial joint replacements who were admitted to our hospital between January 2015 and January 2016 were randomly divided into two groups. The observation group was treated with low molecular heparin by subcu- taneous injection and intermittent pneumatic compression to both lower limbs alternately, while the control group was treated with low molecular heparin alone after operation. The clinical symptoms of venous thromboembolism were observeded, deep venous thrombosis of both lower limbs examined by eolour duplex uhrasonography , and platelet count and blood coagulation were monitored after operation to check the presence of DVT. Results The incidence rates of venous thromboembolism in lower limbs after operation were significantly lower in the observation group than in the control group, so was the amount of bleeding. Pulmonary embolism did not occur in any of the cases. International normalized ratio（INR） did not exceed 2.5 and platelet count did not decrease. Conclusions LMWH in combina- tion with IPC can significantly reduce the incidence of VTE after hip or knee surgery, and is quite safe.