间歇充气加压泵最佳治疗时间对呼吸科危重症患者深静脉血栓的影响

Effect of optimal time of intermittent pneumatic compression on deep venous thrombosis of critical patients in respiratory department

目的探讨不同间歇充气加压泵(IPC)治疗时间对呼吸科危重症患者深静脉血栓(DVT)的影响。方法选择2018年7月至2019年10月南京大学医学院附属鼓楼医院呼吸与危重症医学科收治的危重症患者105例为研究对象。将其按照随机数字表法分为试验1组、试验2组和试验3组,每组35例。试验1组IPC治疗时间为30 min/次,2次/d;试验2组IPC治疗时间为40 min/次,2次/d;试验3组IPC治疗时间为1 h/次,2次/d。治疗2周后观察3组患者DVT、下肢深部组织损伤发生率;比较治疗前后3组患者凝血指标变化情况。结果3组DVT发生率比较差异无统计学意义(P>0.05);试验3组下肢深部组织损伤发生率为22.9%(8/35),明显高于试验1组的2.9%(1/35)和试验2组的5.7%(2/35),差异有统计学意义(χ^(2)值为6.248、4.200,P<0.05)。治疗2周后,试验1组纤维蛋白原(Fbg)、D-二聚体(D-D)为(5.32±1.82)g/L、(0.71±0.38)mg/L,试验2组为(4.15±1.82)g/L、(0.39±0.13)mg/L,试验3组为(3.75±1.46)g/L、(0.33±0.14)mg/L,试验2组、试验3组Fbg、D-D明显低于试验1组(t值为2.131~3.977,P<0.05),但试验2组和试验3组各凝血指标差异无统计学意义(P>0.05)。结论40 min/次、2次/d的IPC治疗时间可以明显改善呼吸科危重症患者凝血功能,且不增加下肢深部组织损伤发生率,值得临床推广。

Objective To investigate the effect of optimal time of intermittent pneumatic compression(IPC)on deep venous thrombosis(DVT)of critical patients in respiratory department.Methods Totally,105 critical patients in Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,Nanjing University Medical School from July 2018 to October 2019 were divided into experimental group 1,group 2 and group 3 by random digits table method,with 35 cases in each group.The experimental group 1 received IPC treatment with 30 min every time,twice a day;and group 2 received 40 min every time,twice a day;and group 3 received 1 hour every time,twice a day.The incidence of DVT and deep tissue injury was observed among three groups,meanwhile,the coagulation function index among three groups was compared before and after IPC treatment.Results There was no significant difference in the incidence of DVT among the three groups(P>0.05),however,the deep tissue injury rate were 22.9%(8/35)in the experimental group 3,significantly higher than 2.9%(1/35)in the experimental group 1 and 5.7%(2/35)in experimental group 2,the difference was statistically significant(χ^(2) values were 6.248,4.200,P<0.05).After 2 weeks of treatment,the levels of fbgrinogen and D-Dimer were(5.32±1.82)g/L,(0.71±0.38)mg/L and(4.15±1.82)g/L,(0.39±0.13)mg/L and(3.75±1.46),(0.33±0.14)mg/L in the experimental group 1,experimental group 2,experimental group 3,respectively;the fbgrinogen and D-Dimer was significantly decreased in the experimental group 2 and experimental group 3 compared to the experimental group 1(t values were 2.131-3.977,P<0.05),however,there was no significant difference between experimental group 2 and experimental group 3(P>0.05).Conclusions IPC can be extend to 40 min every time,twice a day,which can significantly improve coagulation function and do not increase the incidence of skin pressure injury of critical patients in respiratory department.It is worth being applied in clinic.