人工关节置换术后间歇充气压力泵使用时间对下肢深静脉血栓形成的影响

Effect of different use time of intermittent pneumatic compression on the incidence of deep vein thrombosis of lower extremities after arthroplasty

目的探讨人工关节置换术后间歇充气压力泵(intermittent pneumatic compression,IPC)使用时间对下肢深静脉血栓形成(deep vein thrombosis,DVT)的影响。方法将2018年10月—2019年2月拟行单侧人工全髋、膝关节置换术并符合选择标准的94例患者纳入研究,按照随机数字表法随机分为对照组(47例)及试验组(47例)。两组患者性别、年龄、手术部位及手术原因比较,差异均无统计学意义(P>0.05)。两组术后返回病房即开始IPC治疗,其中试验组使用至手术当天晚上9点,对照组至术后第1天早上8点。记录并比较两组患者以下指标:血红蛋白、血小板计数、D-二聚体水平,住院时间、治疗费用、患者使用IPC满意度;血栓弹力图检测,包括凝血形成时间(K值)、凝固角(α角)、反应时间(R值)、血栓最大振幅(MA值);疼痛视觉模拟评分(VAS);手术前后小腿周径差值;匹兹堡睡眠评估量表评估患者睡眠情况;彩色超声多普勒检查下肢DVT情况。结果试验组及对照组患者术前D-二聚体及血栓弹力图K值差异有统计学意义(P<0.05),术后差异无统计学意义(P>0.05);两组手术前后血红蛋白、血小板计数及其他血栓弹力图指标比较,差异均无统计学意义(P>0.05)。两组患者术前及术后各时间点VAS评分比较,术后各时间点小腿周径差值比较,差异均无统计学意义(P>0.05)。试验组术后第1天睡眠评分明显低于对照组(t=2.107,P=0.038)。两组患者住院时间及治疗费用比较,差异均无统计学意义(P>0.05)。术后试验组发生下肢DVT 1例(2.1%)、肌间静脉血栓3例(6.4%)、感染1例(2.1%),对照组分别为2例(4.3%)、4例(8.5%)、0例(0),差异均无统计学意义(P>0.05)。IPC治疗结束后,试验组患者使用IPC满意率为89.4%(42/47),高于对照组的70.2%(33/47),但差异无统计学意义(χ2=0.097,P=0.104)。结论人工关节置换术后短时间应用IPC,不会增加疼痛及小腿肿胀程度,可有效预防下肢DVT,改善患者睡眠情况,有利于术侧肢体康复。

Objective To investigate the effect of different use time of intermittent pneumatic compression(IPC)on the incidence of deep vein thrombosis(DVT)of lower extremities after arthroplasty.Methods Between October 2018 and February 2019,94 patients who planned to undergo unilateral total hip or knee arthroplsty and met the selection criteria were randomly divided into a control group(47 cases)and a trial group(47 cases).There was no significant difference in gender,age,surgical site,and surgical reason between the two groups(P>0.05).After returning to the ward,all patients were treated with IPC.And the IPC was used until 9:00 pm on the day after operation in the trial group and until 8:00 am the next day after operation in the control group.The levels of hemoglobin,platelet count,D-dimer,hospital stay,treatment costs,patients’satisfaction with IPC,the parameters of thromboelastrography[kinetics(K value),freezing angle(αangle),reaction time(R value),maximum amplitude(MA value)],visual analogue scale(VAS)score,circumference difference of calf before and after operation,Pittsburgh sleep assessment score,and the incidence of DVT of lower limbs were recorded and compared between the two groups.Results The K value and D-dimer before operation were significant different between the two groups(P<0.05).There was no significant difference in pre-and postoperative hemoglobin,platelet count,and the other parameters of thromboelastography between the two groups(P>0.05).There was no significant difference in pre-and post-operative VAS scores and post-operative circumference difference of calf between the two groups(P>0.05).The sleep assessment score of the trial group at 1 day after operation was significant lower than that of the control group(t=2.107,P=0.038).There was no significant difference in the hospital stay and treatment costs between the two groups(P>0.05).There was 1 case(2.1%)of DVT,3 cases(6.4%)of intermuscular venous thrombosis,and 1 case(2.1%)of infection in the trial group,and 2 cases(4.3%),4 cases(8.5%),and 0(0)in the control group.The differences were not significant(P>0.05).After the completion of postoperative IPC treatment,the satisfaction rates of using IPC were 89.4%(42/47)in the trial group and 70.2%(33/47)in the control group,and the difference was not significant(χ2=0.097,P=0.104).Conclusion IPC using for a short period of time after arthroplasty do not increase the degrees of the pain and the swelling of calf;it can effectively prevent DVT of the lower extremity,improve the quality of sleep in patients,and is good for the limbs rehabilitation.