术中干预对骨科患者术后住院期间发生下肢深静脉血栓的预防作用

Preventive effect of the intraoperative intervention on lower extremity deep vein thrombosis in orthopedic patients during postoperative hospitalization

目的 探讨术中干预对骨科患者术后住院期间发生下肢深静脉血栓(DVT)的预防作用。方法 收集2021年1—12月于海安市人民医院接受手术治疗的128例骨科患者的临床资料,根据术中管理措施的不同将患者分为对照组(n=71,术中给予常规干预)和干预组(n=57,在常规干预的基础上给予加强干预)。比较两组患者的手术相关指标。复查并比较两组患者术后住院期间下肢DVT的发生情况,手术前后的D-二聚体水平、双下肢大腿周径差以及其他相关检验指标,包括白细胞计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、血红蛋白水平、血小板计数。结果 干预组患者全身麻醉的使用率和术中低体温的发生率均低于对照组患者,差异均有统计学意义(P<0.05)。术后住院期间,干预组患者下肢DVT的发生率低于对照组患者,差异均有统计学意义(P<0.05)。对照组患者的术后D-二聚体水平、大腿周径差均高于本组术前及干预组患者,差异均有统计学意义(P<0.05)。术后住院期间,干预组患者的白细胞计数低于对照组患者,PT、APTT均长于对照组患者,INR高于对照组患者,差异均有统计学意义(P<0.05)。结论 术中干预可显著降低骨科患者术后住院期间下肢DVT的发生风险,值得临床推广。

Objective To explore the preventive effect of the intraoperative intervention on lower extremity deep vein thrombosis(DVT) in orthopedic patients during postoperative hospitalization. Method The clinical data of 128orthopedic patients who underwent surgery in the operating room of Hai’an Municipal People’s Hospital from January 2021 to December 2021 were collected. Patients were divided into control group(n=71, given routine treatment during operation) and intervention group(n=57, given intensive management based on the routine treatment) according to different intraoperative management measures. The surgery-related indicators of the two groups of patients were compared. During postoperative hospitalization, the occurrence of lower extremity DVT was reexamined and compared between the two groups. The D-dimer level, the difference in thigh circumference of both lower extremities, and other relevant test indicators, including white blood cell count, prothrombin time(PT), activated partial thromboplastin time(APTT), international normalized ratio(INR), hemoglobin level, and platelet count, were compared between the two groups before and after the surgery. Result The utilization rate of general anesthesia and the incidence rate of intraoperative hypothermia in the intervention group were both lower than those in the control group, and the differences were statistically significant(P<0.05). During postoperative hospitalization, the incidence rate of lower extremity DVT in the intervention group was lower than that in the control group, and the differences were statistically significant(P<0.05). The postoperative D-dimer level and thigh circumference differences in the control group were higher than those in the preoperative and intervention groups, and the differences were statistically significant(P<0.05). During postoperative hospitalization, the white blood cell count of the intervention group was lower, PT and APTT were longer, and INR was higher than those of the control group, and the differences were statistically significant(P<0.05). Conclusion Intraoperative intervention could significantly reduce the risk of lower extremity DVT in orthopedic patients during postoperative hospitalization, which is worthy of clinical promotion.