活体肝移植供者围手术期下肢深静脉血栓形成风险及优化策略

Risk factor and optimal strategy of perioperative lower limb venous thrombosis in living donor liver transplantation

目的:探讨活体肝移植供者腹腔镜活体供肝获取术(LLDH)术中使用空气加压治疗仪预防下肢深静脉血栓(DVT)形成的疗效。方法:回顾性分析2021年5月至12月在首都医科大学附属北京友谊医院行LLDH供者临床资料,将5~8月采用常规术中护理的25例供者作为对照组,将9~12月在常规术中护理基础上预防性使用空气加压治疗仪的25例供者作为观察组。观察并比较两组供者年龄、性别、体质指数(BMI)、住院时间、LLDH术后双下肢DVT发生情况以及术后第1天血清D-二聚体、纤维蛋白降解产物(FDP)、凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、抗凝血酶(AT)-Ⅲ、凝血酶原时间(PT)、国际标准化比值(INR)、纤维蛋白原(Fbg)和血小板水平。正态分布计量资料采用成组t检验比较,计数资料采用χ^(2)检验比较。P<0.05为差异具有统计学意义。结果:对照组和观察组供者LLDH术后DVT发生率分别为8.0%(2/25)、0%(0/25),差异无统计学意义(χ^(2)=2.083,P>0.05)。观察组供者术后第1天D-二聚体和FDP分别为(0.58±0.25)、(2.9±1.9)mg/L,均低于对照组(0.81±0.43)、(5.3±4.9)mg/L,差异均有统计学意义(t=2.365和2.316,P均<0.05)。两组供者性别、年龄、BMI、住院时间以及术后第1天PTA、APTT、AT-Ⅲ、PT、INR、Fbg和血小板水平差异均无统计学意义(P均>0.05)。结论:术中预防性使用空气加压治疗仪可有效降低D-二聚体和FDP水平,减少术后下肢DVT发生风险,具有进一步推广的价值和意义。

Objective:To investigate the effect of air pressure therapeutic apparatus in the prevention of deep vein thrombosis (DVT) of lower extremity during laparoscopic living donor hepatectomy (LLDH).Methods:The clinical data of donors with LLDH in the Beijing Friendship Hospital from May to December 2021 were retrospectively analyzed. From May to August, 25 patients receiving routine intraoperative nursing were included in the control group. From September to December, 25 patients receiving air pressure therapeutic apparatus on the basis of routine intraoperative nursing were enrolled in the observation group. Age, sex, body mass index (BMI), length of hospital stay, incidence of DVT in lower limbs after LLDH, serum D-dimer, fibrin degradation product (FDP), prothrombin activity (PTA), activated partial thromboplastin time (APTT), antithrombin (AT)-Ⅲ, prothrombin time (PT), international normalized ratio (INR), fibrinogen (Fbg), and platelet levels on day 1 after LLDH were observed and compared between the two groups. The normal distribution measurement data were compared by group t test. Counting data were compared by Chi-square test. P<0.05 was considered statistically significant.Results:The incidence of postoperative DVT was 8.0% (2/25), 0% (0/25) in the control group and observation group, respectively (χ^(2)=2.083, P>0.05). The D-dimer level and FDP in the observation group [(0.58±0.25) and (2.9±1.9) mg/L] were lower than those in the control group [(0.81±0.43) and (5.3±4.9) mg/L], respectively (t=2.365 and 2.316, all P<0.05). There were no significant differences in age, sex, BMI, length of hospital stay, PTA, APTT, AT-Ⅲ, PT, INR, Fbg and platelet levels on the first day after LLDH between the two groups (all P>0.05).Conclusions:Intraoperative preventive use of air pressure therapy apparatus can effectively reduce the D-dimer and FDP levels, and reduce the risk of postoperative DVT of lower limbs, which has the value and significance of further promotion.