下肢抬高程度对下肢静脉曲张患者围手术期下肢周长和疗效的影响

Effect of lower extremity elevation on perioperative period lower extremity circumference and efficacy in patients with varix of lower limb

目的探讨下肢抬高程度对下肢静脉曲张患者围手术期下肢周长和疗效的影响。方法选取2019年6月至2020年6月河北医科大学第一医院收治的90例下肢静脉曲张患者为研究对象,根据随机数字表法将入选患者分为抬高10 cm组、抬高20 cm组、抬高30 cm组(术前摇高床尾抬高患肢,患肢较心脏水平分别抬高10 cm、20 cm、30 cm),每组各30例,三组患者均行大隐静脉高位结扎剥脱术。比较三组患者手术前后下肢周长、简化舒适状况量表(general comfort questionnaire,GCQ)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分、心理状态变化,评估三组患者的治疗效果和安全性。结果三组患者术后1 h下肢周长均显著长于本组术前(均P<0.05),术后8 h、12 h、24 h下肢周长均显著短于本组术前(均P<0.05)。抬高20 cm组和抬高30 cm组患者术后4 h、8 h、12 h、24 h下肢周长均显著短于同期抬高10 cm组(均P<0.05)。三组患者术后24 h GCQ评分、焦虑自评量表(self-rating anxiety scale,SAS)评分、抑郁自评量表(self-rating depression scale,SDS)评分均显著低于本组术前(均P<0.05),PSQI评分均显著高于本组术前(均P<0.05);抬高30 cm组患者术后24 h GCQ评分显著低于同期抬高10 cm组和抬高20 cm组(均P<0.05),PSQI评分、SAS评分和SDS评分均显著高于同期抬高10 cm组和抬高20 cm组(均P<0.05)。抬高10 cm组患者术后并发症发生率显著高于抬高20 cm组和抬高30 cm组(均P<0.05)。抬高20 cm组和抬高30 cm组患者术后3个月残余静脉团块评分均显著低于抬高10 cm组(均P<0.05),皮肤颜色改善率均显著高于抬高10 cm组(均P<0.05)。结论大隐静脉高位结扎剥脱术围手术期下肢抬高20 cm,可提高下肢静脉曲张患者术后舒适度和睡眠质量,促进术后恢复,降低并发症发生率。

Objective To explore the effect of lower extremity elevation on perioperative period lower extremity circumference and efficacy in patients with varix of lower limb.Method A total of 90 patients with varix of lower limb admitted to the First Hospital of Hebei Medical University from June 2019 to June 2020 were selected as the research objects.According to the random number table method,they were divided into 10 cm elevation group,20 cm elevation group and 30 cm elevation group(before operation,the foot of the bed was shaken to raise the affected limb,which was 10 cm,20 cm,and 30 cm higher than the level of the heart),with 30 cases in each group.All patients in the three groups received high ligation and dissection of the great saphenous vein.Lower limb circumference,general comfort questionnaire(GCQ)score,Pittsburgh sleep quality index(PSQI)score and psychological state changes before and after operation were compared among the three groups.The efficacy and safety of the three groups were evaluated.Result The circumference of lower extremity in the three groups at 1 h after operation was significantly longer than those before operation(all P<0.05);the circumference of lower extremity at 8 h,12 h and 24 h after operation were significantly shorter than those before operation(all P<0.05);the circumference of lower extremity at 4 h,8 h,12 h and 24 h after operation in 20 cm elevation group and 30 cm elevation group were significantly shorter than those in 10 cm elevation group(all P<0.05).The scores of GCQ,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)at 24 h after operation in the three groups were significantly lower than those before operation(all P<0.05),and the PSQI were significantly higher than those before operation(all P<0.05);the GCQ score at 24 h after operation in 30 cm elevation group was significantly lower than that in 10 cm elevation group and 20 cm elevation group(all P<0.05),and the scores of PSQI,SAS and SDS were significantly higher than those in 10 cm elevation group and 20 cm elevation group(all P<0.05).The incidence of postoperative complications in 10 cm elevation group was significantly higher than those in 20 cm elevation group and 30 cm elevation group(all P<0.05).The score of residual vein mass in 20 cm elevation group and 30 cm elevation group were significantly lower than that in 10 cm group(all P<0.05),and the improvement rate of skin color were significantly higher than that in 10 cm group(all P<0.05).Conclusion Elevation of lower extremity by 20 cm during perioperative period of high ligation and dissection of great saphenous vein can improve postoperative comfort and sleep quality of varix of lower limb patients,promote postoperative recovery,and reduce the incidence of complications.