围手术期综合干预对骨盆及下肢骨折术后住院期间发生深静脉血栓的预防价值

Preventive value of perioperative comprehensive intervention for deep vein thrombosis during hospitalization after pelvic and lower limb fractures surgery

目的探讨围手术期综合干预对骨盆及下肢骨折术后住院期间发生深静脉血栓(DVT)的预防价值。方法收集2021年6月至2023年6月于首都医科大学附属北京积水潭医院接受手术治疗的200例骨盆及下肢骨折患者的临床资料,根据围手术期是否接受综合干预将患者分为观察组(n=93,接受围手术期综合干预)和对照组(n=107,未接受围手术期综合干预)。比较两组患者的骨折专科信息和手术相关指标,术后住院期间相关指标以及术后住院期间并发症发生情况。结果观察组患者全身麻醉、术中低体温的比例均低于对照组患者,术后启动低分子肝素的时间短于对照组患者,差异均有统计学意义(P﹤0.05)。术后住院期间,两组患者均未发生明显的出血,但两组患者的卧床时间,感染、恶心呕吐并发症的发生率比较,差异均无统计学意义(P﹥0.05)。观察组患者术后D-二聚体水平升高的比例、下肢DVT的发生率均低于对照组患者,差异均有统计学意义(P﹤0.05)。结论围手术期综合干预可降低骨盆及下肢骨折患者术后住院期间DVT的发生率,降低全身麻醉和术中低体温的比例,缩短术后启动低分子肝素的时间,安全性好,值得临床推广和进一步研究。

Objective To investigate the preventive value of perioperative comprehensive intervention for deep vein thrombosis(DVT)during hospitalization after pelvic and lower limb fractures surgery.Method The clinical data of 200 cases patients with pelvic and lower limb fractures who underwent surgical treatment at Beijing Jishuitan Hospital,Capital Medical University from June 2021 to June 2023 were collected.According to whether they received comprehensive intervention during the perioperative period,the patients were divided into observation group(n=93,receiving comprehensive intervention during the perioperative period)and control group(n=107,not receiving comprehensive intervention during the perioperative period).The specialized information on fractures and surgical related indicators,relevant indicators during postoperative hospitalization,as well as the incidence of postoperative complications during hospitalization between two groups of patients were compared.Result The proportion of general anesthesia and intraoperative hypothermia in the observation group patients were lower than those in the control group patients,and the time for initiating low molecular weight heparin after surgery was shorter than that of the control group patients,with statistically significant differences(P<0.05).During the postoperative hospitalization,neither group of patients experienced significant bleeding,but there were no statistically significant differences in bed rest time,incidence of infection,incidence of nausea and vomiting between the two groups(P>0.05).The proportion of postoperative D-dimer levels increased and the incidence of lower limb DVT in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Comprehensive perioperative intervention can significantly reduce the incidence of DVT during hospitalization after pelvic or lower limb fracture surgery,reduce the proportion of general anesthesia and intraoperative hypothermia,shorten the time for initiating low molecular weight heparin after surgery,and have good safety,it is worthy of clinical promotion and further research.