改良截石位联合快速康复外科干预对腹腔镜全子宫切除术中下肢深静脉血栓的预防效果

Effect of modified lithotomy position combined with enhanced recovery after surgery in preventing lower extremity deep vein thrombosis in laparoscopic total hysterectomy

目的探讨改良截石位联合快速康复外科(ERAS)干预措施对腹腔镜全子宫切除术中下肢深静脉血栓(DVT)的预防效果。方法选取2018年8月至2021年5月亳州市人民医院收治的102例行腹腔镜全子宫切除术患者,按照随机数字表法将患者分为试验组(n=51,采取改良截石位联合ERAS)和对照组(n=51,采取传统截石位联合常规干预)。比较两组患者术中不同时间点(入室时、手术开始10 min、手术开始30 min、手术进行1 h、手术结束放平双腿时)的血压。比较两组患者干预前后的凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平、D-二聚体(D-D)水平]、手术相关指标(手术时间、术后首次排气时间、术后自主活动时间、住院时间)及患者满意度。结果入室时,两组患者的收缩压比较,差异无统计学意义(P>0.05);其他各时间点试验组患者的收缩压均明显高于对照组患者(P<0.01)。入室时、手术开始10 min,两组患者的舒张压比较,差异无统计学意义(P>0.05);其他各时间点试验组患者的舒张压均明显高于对照组患者(P<0.01)。干预后,试验组患者的PT、APTT、TT均长于对照组患者,FIB、D-D水平均低于对照组患者(P<0.05)。试验组患者的手术时间、术后首次排气时间、术后自主活动时间、住院时间均短于对照组患者,满意度高于对照组患者(P<0.05)。结论改良截石位联合ERAS干预措施能够有效预防腹腔镜全子宫切除术患者术中下肢深静脉血栓形成,促进患者机体功能的恢复,缩短住院治疗时间。

Objective To investigate the effect of modified lithotomy position combined with enhanced recovery after surgery(ERAS)in preventing lower extremity deep vein thrombosis(DVT)in laparoscopic total hysterectomy.Method A total of 102 patients requiring laparoscopic total hysterectomy admitted to Bozhou People’s Hospital from August 2018 to May 2021 were selected and the patients were divided into experimental group(n=51,modified lithotomy position combined with ERAS)and control group(n=51,traditional lithotomy position combined with routine intervention)according to random number table.The blood pressure of the two groups were compared at different time during the operation(at the time of entering the operation room,10 min after beginning operation,30 min after beginning operation,1 h after beginning operation and the time of legs flattened after operation).The coagulation function indexes[prothrombin time(PT),activated partial thrombin time(APTT),thrombin time(TT),fibrinogen(FIB)level,D-dimer(D-D)]before and after intervention,operation-related indexes(operation time,first postoperative exhaust time,postoperative autonomous activity time,length of hospital stay)and patient satisfaction were compared between the two groups.Result There was no significant difference in systolic blood pressure between the two groups at the time of entering the operation room(P>0.05);the systolic blood pressure of experimental group was significantly higher than that of control group at other time points(P<0.01).There was no significant difference in diastolic blood pressure between the two groups at the time of entering the operation room and 10 minutes after beginning operation(P>0.05);the diastolic blood pressure of experimental group was significantly higher than that of control group at other time points(P<0.01).After intervention,PT,APTT and TT of experimental group were all longer than those of control group,while FIB and D-D levels were all lower than those of control group(P<0.05).The operation time,first postoperative exhaust time,postoperative autonomous activity time and length of hospital stay of experimental group were all shorter than those of control group,the satisfaction of experimental group was higher than that of control group(P<0.05).Conclusion Modified lithotomy position combined with ERAS can effectively prevent lower extremity deep vein thrombosis in patients undergoing laparoscopic total hysterectomy,promote the recovery of body function and shorten the duration of hospitalization.