梯度压力弹力袜联合足底动静脉泵干预对乳房重建术后下肢静脉栓塞的预防研究

Study on the prevention of lower extremity venous embolism after breast reconstruction by graduated compression stockings combined with plantar arteriovenous pump intervention

目的探讨梯度压力弹力袜联合足底动静脉泵干预对乳房重建术后下肢静脉栓塞的预防效果。方法选择2018年1月至2022年3月郑州大学第一附属医院收治的90例乳房重建术患者作为研究对象,根据随机数表法将患者分为对照组和观察组各45例。对照组患者采用足底动静脉泵干预,观察组患者在对照组干预的基础上联合梯度压力弹力袜干预,两组患者均连续干预两周。比较两组患者干预前及干预结束后的大腿和小腿的根部周径、下肢静脉峰值流速、胫后静脉平均流速、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]水平,并记录干预期间下肢静脉栓塞及下肢水肿的发生率。结果干预前,两组患者的大腿和小腿的根部周径、下肢静脉峰值流速、胫后静脉平均流速、凝血功能指标比较差异均无统计学意义(P>0.05);干预结束后,观察组患者的大腿、小腿根部周径分别为(58.37±3.06)cm、(38.70±4.14)cm,明显小于对照组的(60.12±4.92)cm、(41.28±5.39)cm,下肢静脉峰值流速、胫后静脉平均流速分别为(17.80±3.13)cm/s、(8.55±1.84)cm/s,明显快于对照组的(15.65±3.04)cm/s、(7.01±1.49)cm/s,APTT、TT、PT、FIB分别为(30.28±3.37)s、(14.59±2.04)s、(11.59±1.85)s、(2.83±0.21)mg/L,明显低于对照组的(32.51±3.66)s、(16.87±2.13)s、(12.03±1.67)s、(3.54±0.40)mg/L,差异均有统计学意义(P<0.05);干预期间,观察组患者的下肢静脉栓塞、下肢水肿的发生率分别为4.44%、6.67%,明显低于对照组的17.78%、22.22%,差异均有统计学意义(P<0.05)。结论乳房重建术后采用梯度压力弹力袜联合足底动静脉泵干预,能改善患者的下肢周径、下肢静脉流速和凝血功能,降低下肢静脉栓塞和水肿的发生率,值得临床推广应用。

Objective To investigate the prevention of lower extremity venous embolism after breast reconstruction by graduated compression stockings combined with plantar arteriovenous pump intervention.Methods Ninety patients who underwent breast reconstruction surgery at the First Affiliated Hospital of Zhengzhou University from January 2018 to March 2022 were selected as the research objects.According to the random number table method,the patients were divided into a control group and an observation group,with 45 cases in each group.The patients in the control group were treated with plantar arteriovenous pump intervention,and the patients in the observation group were treated with graduated compression stockings on the basis of the intervention of the control group,continuously for 2 weeks.The root circumference of the thighs and calves,peak flow velocity of lower limb veins,average flow velocity of posterior tibial veins,and coagulation function indicators[activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),fibrinogen(FIB)]levels before and after intervention were compared between the two groups.The incidence of lower limb venous embolism and edema during the intervention period was recorded.Results Before the intervention,there was no statistically significant difference in the root circumference of the thighs and calves,peak venous flow velocity of the lower limbs,average venous flow velocity of the posterior tibia,and coagulation function indicators between the two groups(P>0.05).After the intervention,the root circumference of the thighs and calves in the observation group were(58.37±3.06)cm and(38.70±4.14)cm,respectively,which were significantly smaller than(60.12±4.92)cm and(41.28±5.39)cm in the control group;the peak flow velocity of the lower limb vein and the average flow velocity of the posterior tibial vein were(17.80±3.13)cm/s and(8.55±1.84)cm/s,respectively,significantly faster than(15.65±3.04)cm/s and(7.01±1.49)cm/s in the control group;the APTT,TT,PT,FIB values were(30.28±3.37)s,(14.59±2.04)s,(11.59±1.85)s,and(2.83±0.21)mg/L,respectively,significantly lower than(32.51±3.66)s,(16.87±2.13)s,(12.03±1.67)s,and(3.54±0.40)mg/L in the control group(P<0.05).During the intervention period,the incidence rates of lower limb venous embolism and lower limb edema in the observation group were 4.44%and 6.67%,respectively,which were significantly lower than 17.78%and 22.22%in the control group(P<0.05).Conclusion After breast reconstruction,graduated compression stockings combined with plantar artervenous pump intervention can improve lower limb diameter,lower limb venous flow rate and coagulation function,and reduce the incidence of lower limb venous embolism and edema,which is worthy of clinical application.