间歇性充气加压预防重症肺炎患者深静脉血栓形成的临床研究

Clinical study of intermittent pneumatic compression in the prevention of deep venous thrombosis in patients with severe pneumonia

目的探讨重症肺炎患者于住院期间应用间歇性充气加压术预防下肢深静脉血栓(DVT)形成的疗效,从而为完善临床诊疗提供参考依据.方法基于十堰市太和医院往年同期相关患者就诊量的分布情况,连续性、前瞻性纳入医院呼吸内科于2017年4月19日起收治的80例重症肺炎患者,使用Excel软件RA ND函数将其随机分为对照组和试验组,试验组在对照组基础上给予间歇性充气加压术干预.比较2组患者入院后4d、7d时股静脉血液流速及相关凝血功能指标,并随访6个月以明确出院后相关预后情况.结果经纳入及排除标准,本研究至2018年4月25日截止,完成80例研究对象的数据搜集.并于2018年11月10日完成入选队列中最后一例患者的随访,随访期内累计4例患者失访(对照组2例、试验组2例),失访率5.00%.2组患者包括重症肺炎评分、CURB-65评分、Wells量表评分在内的基线资料相比差异无统计学意义.与对照组比较,试验组患者入院4 d后收缩期峰值血流速度(PSV)显著上升,差异有统计学意义(P<0.05);至住院7d时,试验组的PSV及平均血流速度均显著增加,差异有统计学意义(P<0.05);并且试验组入院后D-二聚体显著下降,差异有统计学意义(P<0.05).对2组患者的随访进程进行Kaplan-meier生存分析,相比对照组,试验组患者出院后继发DV T的预后趋势得到显著改善,其差异有统计学意义(Log Rankχ2=3.859,P<0.05).结论对于重症肺炎患者,给予间歇性充气加压术干预,可有效降低DVT的发病率.

Objective To investigate the efficacy of intermittent pneumatic compression in the treatment of severe deep vein thrombosis ( DVT ) in patients with severe pneumonia during hospitalization .Therefore ,it provides a reference for improving clinical diagnosis and treatment . Methods Based on the distribution of relevant patient visits in the same period of the previous year in Shiyan City ,Taihe Hospital ,continuous and prospective enrollment in 80 patients with severe pneumonia admitted to the hospital from October 19th ,2017 .They were randomly divided into a control group and an experimental group using the Excel software RAND function . The experimental group was treated with intermittent inflation and compression on the basis of the control group .The blood flow velocity and related coagulation function of the femoral vein were compared between the two groups on the 4th and 7th day after admission .The patients were followed up for 6 months after discharge to determine the prognosis after discharge .Results After inclusion and exclusion criteria ,the study was completed on April 25 ,2018 ,and data collection of 80 subjects was completed .On November 10 ,2018 ,the last patient in the enrolled cohort was followed up .During the follow-up period ,4 patients were lost to follow-up ( 2 in the control group and 2 in the experimental group),and the rate of loss of follow-up was 5 .00%.There were no significant differences in baseline data between the two groups including the severity of the pneumonia score , the CURB-65 score ,and the Wells scale score .Compared with the control group ,the peak systolic velocity ( PSV) of the experimental group was significantly increased after 4 days of admission ,and the difference was statistically significant ( P <0 .05).By the 7th day of hospitalization ,the PSV and mean flow velocity of the experimental group increased significantly ,and the difference was statistically significant ( P < 0 .05 ). D-dimer decreased significantly after admission in the experimental group ,and the difference was statistically significant ( P < 0 .05 ).Kaplan-Meier survival analysis was performed on the follow-up of the two groups .Compared with the control group ,the prognostic trend of the patients with DVT after discharge was significantly improved in the experimental group .The difference was statistically significant ( Log Rank χ2 = 3 .859 , P <0 .05).Conclusions For patients with severe pneumonia ,intermittent inflation and compression intervention can effectively reduce the incidence of DVT .