加温弹力袜预防后路腰椎椎间融合术患者下肢深静脉血栓形成和低体温的效果

Effects of heated medical elastic stockings on the prevention of deep venous thrombosis and hypothermia of lower limbs during posterior lumbar intervertebral fusion

目的自制一种加温式医用弹力袜，用于预防腰椎退行性疾患行后路腰椎椎间融合术（PLIF）患者术中下肢深静脉血栓（DVT）和低体温的发生。方法采用目的抽样法选择2015年2月-2017年2月腰椎退行性疾患行PLIF患者180例，按手术时间先后顺序分成常规组（A组）、普通弹力袜（B组）、加温弹力袜组（c组），每组各60例。在给予常规保暖措施和DVT基础预防措施的前提下，A组不穿弹力袜，B组穿着普通弹力袜，C组穿着自制的加温弹力袜，于术前1h在麻醉准备间协助B、C组患者分别穿上普通或加温弹力袜。通过监测双下肢深静脉血流速度、D-二聚体水平、足背皮温以及患者术中各时间节点的核心体温来统计A、B、C3组DVT和低体温发生率。结果C组左侧股浅静脉速度（17．47±3．07）cm／s、右侧股浅静脉速度（16．95±3．25）cm／s、左胴静脉血流速度（16．03±3．37）cm／s、右胭静脉血流速度（16．37±3．39）cm/s，均高于A、B组（P〈0．01）；术毕D．二聚体（587±129）μg／L、术后24h的D．二聚体（392±119）μg／L，均低于A、B组（p〈0．01）。A组术毕DVT发生率为8．3％，术后24h发生率为15．0％，B组分别为5．0％、5．0％，C组均无DVT发生，3组术后24hDVT发生率差异有统计学意义（P〈0．01）。手术开始后各时间点温度比较，C组患者的足背皮温和核心体温均高于A、B组（P〈0．05）。C组术中低体温8例（12．5％），低于A组的56．7％和B组的40．0％（P〈0．01）。结论加温式弹力袜能有效降低腰椎退行性疾患行PLIF患者术中DVT和低体温的发生风险，可以在临床推广。

Objective To develop a kind of heated medical elastic stockings to prevent the occurrence of deep vein thrombosis （DVT） and hypothermia in patients with lumbar degenerative diseases undergoing posterior lumbar intervertebral fusion （PLIF）. Methods A total of 180 patients with lumbar degenerative diseases undergoing PLIF from February 2015 to August 2017 were selected by purposive sampling method, and divided into routine group （group A）, normal elastic stockings （group B）, heated medical elastic stockings （group C） according to the sequence of operation time, with 60 cases in each group. On the premise of routine thermal protection measures and DVT basic preventive measures, group A did not wear stretch socks, group B wore normal elastic stockings, and group C wore heated medical elastic stockings. Patients in the group B and C were treated with normal and heated stretch stockings during anesthesia preparation 1 hour prior to surgery. The incidence rate of lower extremity DVT and hypothermia in each group was calculated by monitoring deep veins blood flow velocity of both lower limbs, D-dimer, foot temperature and the core temperature at each time nodeduring the operation. Results In group C ： left femoral superficial vein velocity was （17.47 ± 3.07） cm/s ; right femoral superficial vein velocity was （16.95 ±3.25） cm/s; left popliteal vein blood flow velocity was （16.03 ±3.37） cm/s; right popliteal vein blood flow velocity was （16.37 ± 3.39） cm/s. All the results above were higher than those in group A and B （P 〈 0.01）. The D-dimer were （587 ± 129） μ g/L at the end of surgery and （392 ± 119） μg/L 24 h after surgery in group C, which were significantly lower than group A and B （P 〈 0.01）. The incidence of DVT at the end of operation and 24 hour postoperation in group A was 8.3% and 15.0%, while 5.0% and 5.0% in group B respectively. There was no DVT occurrence in group C at the two time points, and the difference was statistically significant （P 〈 0.01）. Comparing foot temperature and core temperature of each time point, it was significantly higher in group C than group A and B （P 〈 0.05）. There were 8 cases of hypothermia in group C, and the incidence rate was 12.5%, which were both significantly lower than that in group A （56.7%） and group B （40.0%） （P 〈 0.01）. Conclusions The heated elastic stockings can effectively reduce the risk of DVT and hypothermia in the patients with lumbar degenerative diseases undergoing PLIF and can be popularized in clinical practice.