围手术期应用彩色多普勒超声血流动力学监测对髋关节置换术后下肢深静脉血栓的预防效果研究

The preventive effect of perioperative Doppler intervention on lower extremity deep vein thrombosis after hip joint replacement

目的探讨围手术期应用彩色多普勒超声血流动力学监测对髋关节置换术后下肢深静脉血栓(DVT)的预防效果。方法回顾性选取2019年5月至2021年12月在青岛市胶州中心医院行髋关节置换术患者227例,按治疗方法分为观察组(115例)和对照组(112例)。对照组围手术期采用常规干预方法预防下肢DVT;观察组在围手术期应用彩色多普勒超声血流动力学监测预防下肢DVT,比较两组恢复进度、股静脉平均血流速度和流峰速度、外周血凝血指标及下肢疼痛程度和Harris髋关节功能量表(HHS)评分,比较两组下肢DVT发生率和肿胀等级。结果观察组首次下床时间、住院时间均短于对照组[(1.00±0.54)d比(2.44±0.72)d、(8.02±1.76)d比(9.80±2.33)d],差异有统计学意义(P<0.05)。术后第5天观察组股静脉血流峰速度和平均血流速度大于对照组[(61.27±10.26)cm/s比(51.66±12.57)cm/s、(35.72±6.09)c m/s比(30.11±8.74)cm/s],活化部分凝血活酶时间(APTT)低于对照组[(15.69±1.72)s比(18.60±2.66)s],差异有统计学意义(P<0.05)。观察组术后第3、7天视觉模拟量表评分低于对照组[(1.30±0.24)分比(2.99±1.01)分、(1.00±0.25)分比(1.63±0.34)分],差异有统计学意义(P<0.05)。观察组术后第3、7天HHS评分高于对照组[(53.04±2.33)分比(50.70±1.97)分、(64.36±2.75)分比(61.01±6.22)分],差异有统计学意义(P<0.05)。观察组下肢DVT发生率小于对照组[1.32%(2/151)比9.82%(11/112)],差异有统计学意义(χ^(2)=6.86,P<0.05)。观察组肿胀等级低于对照组,差异有统计学意义(P<0.05)。结论髋关节置换术后患者围手术期应用彩色多普勒超声血流动力学监测可有效降低术后下肢DVT风险,促进患者康复。

Objective To explore the clinical value of perioperative Doppler intervention in the prevention of lower extremity deep vein thrombosis(DVT)after hip joint replacement.Methods Two hundred and twenty-seven patients treatment in Jiaozhou Central Hospital of Qingdao with hip joint replacement from May 2019 to December 2021 were selected and they were divided into the observation group(115 cases)and the control group(112 cases)by the random number table method.The control group was treated with routine intervention,and the observation group was treated with Doppler intervention during perioperative period.The recovery progress,the femoral vein blood flow peak velocity and average velocity,peripheral blood coagulation indexes,pain degree of lower limbs and Harris Hip Scale(HHS)score were compared between the two groups.The incidence of DVT and swelling grade of lower limbs were compared between the two groups.Results The first time of getting out of bed and hospitalization time in the observation group were shorter than those in the control group:(1.00±0.54)d vs.(2.44±0.72)d,(8.02±1.76)d vs.(9.80±2.33)d,there were statistical differences(P<0.05).On the 5th day after surgery,the femoral vein blood flow peak velocity and average velocity in the observation group were higher than those in the control group:(61.27±10.26)cm/s vs.(51.66±12.57)cm/s,(35.72±6.09)cm/s vs.(30.11±8.74)cm/s;the activated partial thromboplastin time(APTT)was lower than that in the control group:(15.69±1.72)s vs.(18.60±2.66)s,there were statistical differences(P<0.05).On the 3rd and 7th day after surgery,the scores of Visual Analog Scale(VAS)in the observation group were lower than those in the control group:(1.30±0.24)scores vs.(2.99±1.01)scores,(1.00±0.25)scores vs.(1.63±0.34)scores;and the scores of HHS in the observation group were higher than those in the control group:(53.04±2.33)scores vs.(50.70±1.97)scores,(64.36±2.75)scores vs.(61.01±6.22)scores,there were statistical differences(P<0.05).The total incidence of DVT in the observation group was lower than that in the control group:1.32%(2/151)vs.9.82%(11/112),there was statistical difference(χ^(2)=6.86,P<0.05).The swelling grade of lower limbs in the observation group was lower than that in the control group(P<0.05).Conclusions Perioperative application of Doppler intervention can effectively reduce the risk of DVT and the degree of pain after hip replacement,and promote the rehabilitation of patients.