高龄老人关节置换术后深静脉血栓的防治措施

Experience of prevention and treatment of deep venous thrombosis in elderly patients with arthroplasty

目的探讨高龄老人(髋、膝)关节置换术后下肢深静脉血栓的防治措施。方法总结2012年3月至2016年3月182例行关节置换术高龄患者的临床资料,其中髋关节置换术(THA) 97例101髋,膝关节置换术85例90膝;年龄67～98岁。所有入院患者都行常规血液凝血四项、D-二聚体(D-D)的实验室检查和双下肢血管彩超筛查,且术后1、3、7 d复查D-D和1周后对患肢有肿胀的体征患者,全部行双下肢血管彩超检查,如必要时可进行宝石CT血管造影以明确诊断。所有患者术前均做规范的基本预防治疗,术后加上系统的物理治疗和预防性药物抗凝治疗。结果术后有12例采静脉血栓形成(DVT),其中10例积极治疗后复查下肢血管彩超患肢症状消失,继续恢复康复; 2例转入心内科行抗血栓治疗,待病情稳定后行康复治疗。全部患者在治疗期间均未出现肺栓塞情况。结论对高龄患者应该术前做好充分身体评估和耐心的心理指导,术后早期行物理功能锻炼联合抗凝治疗预防DVT的发生安全有效,D-二聚体可作为老年DVT的监测手段。

Objective To investigate the experience of the prevention and treatment of deep venous thrombosis（ DVT） in the elderly with hip arthroplasty. Methods From March 2012 to March2016,182 elderly patients with arthroplasty underwent total hip arthroplasty（ THA） in 97 patients（ 101 hips） and 85 patients（ 90 knees） underwent knee arthroplasty（ TKA）; Aged 67-98 years old. All hospitalized patients underwent routine blood clotting four,D-dimer（ DD） laboratory tests and double lower extremity vascular color Doppler ultrasound screening,and postoperative 1,3,7 d review D-dimer（ DD）and 1 Week after swelling of the limb symptoms of patients,all of the lower extremity vascular ultrasound examination,if necessary,can be made of precious stones CT angiography（ CTA） to confirm the diagnosis. All patients were done before the standard basic preventive treatment,combined with systematic physical therapy and prophylactic drug anticoagulation therapy. Results DVT was found in 12 patients after operation. Among them,10 patients underwent positive postoperative examination,their symptoms disappeared,and their rehabilitation was continued. Two patients were transferred to cardiothoracic surgery for antithrombotic treatment and were treated with rehabilitation after their condition was stable. Pulmonary embolism did not appear during the treatment in all of the patients.Conclusions It is safe and effective to prevent the occurrence of DVT in elderly patients with adequate physical evaluation and patient psychological guidance before surgery. Early postoperative physical exercise combined with anticoagulant therapy can be used as a safe and effective method for the diagnosis of DVT.