颅脑创伤长期卧床患者下肢静脉血栓形成预防措施的对照性研究

A Comparative Study of Preventive Measures for Venous Thrombosis of Lower Limbs in Patients with Long-Term Bed Rest after Craniocerebral Trauma

目的:对比颅脑创伤长期卧床患者下肢静脉血栓形成不同预防措施的效果。方法:将颅脑创伤长期卧床患者随机分为三组收集数据,共收集病例333例,物理预防组(n=121),药物预防组(n=108),中医手法组(n=104),物理预防组使用空气波压力循环治疗仪、药物预防组使用低分子肝素钠、中医手法组采用穴位按摩及下肢主动被动运动进行预防,干预7天后统计分析下肢静脉血流动力学指标、凝血指标及临床指标(下肢肿胀、DVT、肺栓塞发生率及预防费用)。结果:干预后,三组平均血流量、平均血流速度及峰流速均高于干预前(P<0.05),物理预防组与中医手法组平均血流量、平均血流速度及峰流速高于药物预防组(P<0.05),物理预防组与中医手法组间差异无统计学意义(P>0.05)。干预后,三组D-D、PT及FIB均低于干预前(P<0.05);三组干预后D-D、PT及FIB比较,差异无统计学意义(P>0.05)。干预后,三组下肢肿胀、DVT、肺栓塞发生率及预防费用差异无统计学意义(P>0.05)。结论:物理预防、药物预防及中医手法预防对颅脑创伤长期卧床患者下肢静脉血栓形成均是有效的,中医手法预防无明显禁忌症,适用于绝大部分患者,其不良反应率低、性价比高,对设备、药物依赖性小,操作简单,值得在偏远贫穷地区基层医院推荐开展。

Objective:To compare the effects of different preventive measures on venous thrombosis of lower limbs in patients with long-term bed rest after craniocerebral trauma.Methods:According to different preventive measures,the patients with long-term brain trauma lying in bed were randomly divided into three groups to collect data.333 cases were collected,including the physical prevention group(n=121),drug prevention group(n=108),and traditional Chinese medicine manipulation group(n=104).The physical prevention group used the air wave pressure circulation therapeutic apparatus,the drug prevention group used low molecular weight heparin sodium,and the traditional Chinese medicine manipulation group used point massage and active and passive lower limb movement for prevention,and the hemodynamic indexes,coagulation indexes and clinical indexes of lower limb vein after prevention were statistically analyzed after 7 days of intervention.Results:After intervention,the mean blood flow,mean blood flow velocity and peak flow velocity of the three groups were higher than those before intervention(P<0.05).The average blood flow,average blood flow velocity and peak flow velocity in the physical prevention group and the traditional Chinese medicine manipulation group were higher than those in the drug prevention group(P<0.05).There was no significant difference between the physical prevention group and the traditional Chinese medicine manipulation group(P>0.05).After intervention,D-D,PT and FIB of the three groups were lower than those before intervention(P<0.05).After intervention,there was no significant difference in D-D,PT and FIB among the three groups(P>0.05).After intervention,there was no significant difference in the incidence of lower limb swelling,DVT,pulmonary embolism and prevention costs among the three groups(P>0.05).Conclusion:Physical prevention,drug prevention and traditional Chinese medicine manipulation prevention are all effective for patients with lower limb venous thrombosis who have been in bed for a long time after traumatic brain injury.Traditional Chinese medicine manipulation prevention has no obvious contraindication,and is applicable to most patients.It has low adverse reaction rate,high-cost performance ratio,low dependence on equipment and drugs,and simple operation,which is worth recommending in grass-roots hospitals in remote and poor areas.