Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Clinical Value of Predictive Nursing Intervention on Deep Venous Thrombosis of Lower Extremities after Cesarean Section

[Objectives]To explore the clinical nursing value of predictive nursing intervention in patients with deep venous thrombosis of lower extremities after cesarean section.[Methods]From December 2022 to April 2023,105 pregnant and lying-in women who were hospitalized in the Gynecology Department of Pingquan Hospital and underwent cesarean section and met the inclusion criteria were included as the study objects.According to the medical records,they were divided into observation group(n=52 cases)and control group(n=53 cases).The clinical experimental subjects were divided into two groups.One group was the control group with routine nursing,and the other group was the observation group with predictive nursing intervention.The number of cases of deep venous thrombosis of lower extremities in the two groups was recorded to evaluate the clinical value.[Results]The incidence of deep venous thrombosis of lower extremities in the two groups after cesarean section was compared,and it was suggested that the incidence of the observation group was lower than that of the control group(P<0.05).[Conclusions]Special predictive nursing intervention can greatly reduce the incidence of deep venous thrombosis of lower extremities after cesarean section,improve nursing satisfaction,and improve clinical efficacy,which is worthy of recommendation.

Establishment of a nomogram model for predicting therapy complications in patients with polycythemia and deep venous thrombosis

BACKGROUND Patients with deep venous thrombosis(DVT)residing at high altitudes can only rely on anticoagulation therapy,missing the optimal window for surgery or thrombolysis.Concurrently,under these conditions,patient outcomes can be easily complicated by high-altitude polycythemia(HAPC),which increases the difficulty of treatment and the risk of recurrent thrombosis.To prevent reaching this point,effective screening and targeted interventions are crucial.Thus,this study analyzes and provides a reference for the clinical prediction of thrombosis recurrence in patients with lower-extremity DVT combined with HAPC.AIM To apply the nomogram model in the evaluation of complications in patients with HAPC and DVT who underwent anticoagulation therapy.METHODS A total of 123 patients with HAPC complicated by lower-extremity DVT were followed up for 6-12 months and divided into recurrence and non-recurrence groups according to whether they experienced recurrence of lower-extremity DVT.Clinical data and laboratory indices were compared between the groups to determine the influencing factors of thrombosis recurrence in patients with lowerextremity DVT and HAPC.This study aimed to establish and verify the value of a nomogram model for predicting the risk of thrombus recurrence.RESULTS Logistic regression analysis showed that age,immobilization during follow-up,medication compliance,compliance with wearing elastic stockings,and peripheral blood D-dimer and fibrin degradation product levels were indepen-dent risk factors for thrombosis recurrence in patients with HAPC complicated by DVT.A Hosmer-Lemeshow goodness-of-fit test demonstrated that the nomogram model established based on the results of multivariate logistic regression analysis was effective in predicting the risk of thrombosis recurrence in patients with lowerextremity DVT complicated by HAPC(χ^(2)=0.873;P>0.05).The consistency index of the model was 0.802(95%CI:0.799-0.997),indicating its good accuracy and discrimination.CONCLUSION The column chart model for the personalized prediction of thrombotic recurrence risk has good application value in predicting thrombotic recurrence in patients with lower-limb DVT combined with HAPC after discharge.

Upper extremity deep vein thrombosis:An intensivist’s perspective

Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.

Pitfalls and sources of error of color duplex ultrasonography in detecting deep vein thrombosis of proximal lower extremities

Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Discussion on Prevention and Treatment of Lower Extremity Deep Venous Thrombosis in Orthopedic Perioperative Period from Spleen and Stomach Meridians

Deep venous thrombosis of lower extremity is one of the common complications in orthopedic perioperative period.It is caused by many factors,such as peripheral vein dilation,slow blood flow;long-term immobilization,bed rest and so on.On the one hand,it affects the early postoperative functional exercise and functional recovery,on the other hand,it increases the length of hospital stay and economic burden,increases the pain of patients and even endangers their lives.Effective treatment of traditional Chinese medicine combined with western medicine can play a better role in the prevention and treatment of lower extremity deep venous thrombosis.This study expounds the concept of spleen and stomach meridians in the prevention and treatment of lower extremity deep venous thrombosis,and puts forward some opinions on the dialectical treatment and daily conditioning of lower extremity deep venous thrombosis,hoping to provide ideas for the clinical prevention and treatment of lower extremity deep venous thrombosis in traditional Chinese medicine.

Prevention and Treatment of Deep Vein Thrombosis of the Lower Limbs in Patients with Complications after Orthopedic Trauma Surgery

Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years,and a total of 58 patients were selected.The patients were randomly divided into two groups,with 29 patients in the control group treated with conventional clinical methods;and the other 29 patients were assigned to the experimental group,where targeted preventive and therapeutic measures were administered.During the research,the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients.Results:According to the results of clinical experiments,the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group(P<0.05);in addition,when complications of deep venous thrombosis of the lower limbs occurred,the treatment efficacy of the patients in the experimental group was 96.55%,and the treatment efficacy of the patients in the control group was 82.76%.There was a significant difference between the two groups(P<0.05).Conclusion:Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery,this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.

Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?

BACKGROUND: Deep venous thrombosis(DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department(ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with DVT.METHODS: This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital's electronic medical record.RESULTS: A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379(15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated DVT.CONCLUSIONS: Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.

Comparison of four clinical scores for the predicting lower limb deep venous thrombosis in Chinese patients

Objective：To evaluate Wells, Kahn, St.Andr 6 and Constans scores for the prediction of deep venous thrombosis in Chinese patients. Methods：One hundred and seventy-two patients, prospectively, blinded referred for evaluation with four clinical-score systems for suspected deep venous thrombosis, were examined by ultrasonography. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operation curves were calculated for four clinical scores. The difference between areas of the ROC curve for each of the scores was compared with others and reference line. Results：Forty-six of 172 patients had deep venous thrombosis proven by sonography. The sensitivity, specificity, positive predictive value and negative predictive value for Wells score was 91.3%, 57.1%, 43.8% and 94.7%, respectively, for Kahn score; 65.2%, 71.4%, 45.5% and 84.9%, respectively, for St.Andr 6 score; 63%, 38.9%, 27.4% and 74.2% respectively, for Constans score; 95.7%, 34.9%, 34.9% and 95.7% respectively. Area under ROV curve of Constans score was 0.814, which was similar to that of Wells score, then followed by Kahn score and that of St.Andr 6 score was no difference with the reference line. Conclusion：Based on the results of our study, the sensitivity, negative prediction value and area under ROC curve are larger for Constans score and Wells score in Chinese hospitalized patients than that of Kahn score or St.Andr 6 score. Considering the aim of the clinical assessment, Constans score and Wells score are more efficient for Chinese hospitalized patients.

Combined effect of Traditional Chinese Medicine decoction and low-molecular-weight heparin calcium on the postoperative deep venous thrombosis in patients with lower limb fracture

OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fracture.METHODS: Totally 86 hospitalized patients with DVT after surgery of lower limb fracture between September 2012 and January 2015 were recruited and randomly divided into control group and observation group, 43 cases in each group. The patients in the control group were treated with subcutaneous injection of low-molecular-weight heparin calcium, and those in the observation group were additionally given Danshen Injection and TCM decoction. The differences between two groups in occurrence rate, medication time, therapeutic effects,recurrence rate of thrombosis, activated partial thromboplastin time(APTT), and prothrombin time(PT) were compared.RESULTS: The occurrence rate of DVT in observation group(4.65%, 2/43) was lower than that in control group(27.91%,12/43)(P<0.05). The medication time of observation group was(6.15±2.94) d, shorter than(9.76±3.12) d in the control group(P<0.05). In observation group, 2 cases of DVT were cured(2/2); in the control group, 9 cases presented therapeutic effects and the total effective rate was 75.00%(9/12). The improvement of APTT and PT in the observation group was better than that in the control group(P<0.05).CONCLUSION: Integrative TCM decoction plus low-molecularweight heparin calcium is superior to applicaton of low-molecularweight heparin calcium alone in reducing and treating DVT in the postoperative patients with lower limb fracture.

多元化健康教育模式在预防下肢骨折患者深静脉血栓中的应用

目的探讨多元化健康教育模式在预防下肢骨折患者深静脉血栓中的应用效果。方法采用便利抽样法,选取2021年1~12月收治的下肢骨折患者300例,按照住院时间将2021年1~6月收治的患者作为对照组,将2021年7~12月收治的患者作为观察组,每组150例。对照组采用常规健康教育模式,观察组采用多元化健康教育模式。比较2组患者对深静脉血栓的认知水平、基本预防措施依从性、深静脉血栓的发生率,以及患者对护理工作满意度。结果观察组患者对深静脉血栓的认知水平、对基本预防措施的依从性、护理满意度显著高于对照组(P<0.05)。观察组患者深静脉血栓发生率为16.00%低于对照组的25.33%,差异有统计学意义(P<0.05)。结论将多元化健康教育模式应用于下肢骨折患者,可提高护理效果,降低深静脉血栓的发生率,值得推广应用。

全麻患者术后麻醉重症监护室中新发下肢深静脉血栓的危险因素

目的筛选全麻术后转入麻醉重症监护室(AICU)的患者新发下肢深静脉血栓(DVT)的危险因素。方法回顾性收集2022年5—8月择期行全麻下手术后带气管插管转入AICU的患者192例,男105例,女87例,年龄18~85岁,BMI 18~31 kg/m^(2),ASAⅡ或Ⅲ级。收集患者基线资料、麻醉手术资料及实验室检查资料。根据入AICU 6 h内的超声结果是否有新发DVT将患者分为两组:DVT组和非DVT组。采用多因素Logistic回归分析筛选AICU中患者术后6 h内新发DVT的危险因素及其95%可信区间(CI)。结果全麻术后在AICU新发DVT的患者有64例(33.3%),均为小腿肌间静脉血栓(CMVT)。多因素Logistic回归分析结果显示,术前心律失常(OR=2.236,95%CI 1.011~4.943,P=0.047)、术前血小板计数高(OR=1.006,95%CI 1.002~1.010,P=0.007)、术前D⁃二聚体浓度高(OR=1.203,95%CI 1.046~1.383,P=0.010)、术中低血压(OR=1.010,95%CI 1.002~1.019,P=0.020)和术中应用去甲肾上腺素(OR=3.796,95%CI 1.697~8.492,P=0.001)是全麻术后AICU中患者新发DVT的危险因素;阿司匹林规律服用史(OR=0.176,95%CI 0.060~0.518,P=0.002)是其保护因素。结论术前心律失常、术前血小板计数高、术前D⁃二聚体浓度高、术中低血压及术中应用去甲肾上腺素是全麻手术后AICU患者6 h内新发DVT的危险因素。

基于诺莫图构建髋部骨折患者发生下肢深静脉血栓的预测模型

目的探讨髋部骨折患者发生下肢深静脉血栓(DVT)的独立危险因素,并构建和验证列线图模型。方法选择2020年1月至2023年6月佛山市中医院骨科收治的髋部骨折患者227例为研究对象,按照7∶3比例将患者分为建模组(n=159)和验证组(n=68)。收集患者的临床资料,采用LASSO回归和Logistic回归筛选髋部骨折患者发生DVT的独立危险因素,建立风险预测模型和列线图。采用一致性指数(C-index)、校准曲线、受试者工作特征(ROC)曲线进行评价。结果建模组159例髋部骨折中发生DVT 33例,发生率为20.89%。LASSO回归结合多因素Logistic回归分析结果显示,年龄≥70岁、糖尿病、受伤至手术时间≥5 d、低蛋白血症、D-二聚体>0.5是髋部骨折患者发生DVT的独立危险因素。基于上述危险因素绘制列线图模型,将上述5个危险因素构建列线图模型,模型区分度良好(C-index=0.932);Hosmer-Lemeshow检验显示,列线图的拟合优度良好(χ^(2)=57.625,P=0.732)。建模组和验证组发生DVT的ROC曲线下面积分别为0.932、0.821,模型准确度高。结论年龄≥70岁、糖尿病、受伤至手术时间≥5 d、低蛋白血症、D-二聚体>0.5是髋部骨折患者发生DVT的独立危险因素,基于上述因子构建的列线图模型可有效预测髋部骨折患者发生DVT的风险。

利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果分析

目的分析利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果。方法选取2020年6月至2021年10月于厦门大学附属中山医院就诊的老年粗隆间骨折围手术期患者130例为研究对象。按随机数字表法分为观察组和对照组,每组65例。对照组采用低分子肝素皮下注射预防血栓,观察组采用利伐沙班口服预防血栓。比较2组患者术前及术后2周的凝血指标,术后2周内下肢深静脉血栓形成(DVT)和肺栓塞的发生率,术中出血量、术后引流量及住院时间,术后1 d炎症相关指标。结果2组患者术前、术后2周组间和组内凝血相关指标差异均无统计学意义(均P>0.05)。术后观察组下肢DVT发生率显著低于对照组[4.6%(3/65)比15.4%(10/65)],差异有统计学意义(χ^(2)=4.188,P=0.041)。观察组与对照组术中出血量、术后引流量及住院时间差异均无统计学意义(均P>0.05)。术后1 d观察组降钙素原和C反应蛋白水平显著低于对照组[(0.17±0.02)μg/L比(0.22±0.01)μg/L、(20.2±2.3)mg/L比(23.9±3.6)mg/L],差异均有统计学意义(均P<0.001)。结论利伐沙班与低分子肝素在老年粗隆间骨折患者围手术期均有良好的抗凝效果及安全性,但利伐沙班预防术后下肢DVT发生的效果更显著且口服用药更方便。

脑卒中恢复期患者下肢深静脉血栓风险预测模型的构建及应用

目的 探究脑卒中恢复期患者下肢深静脉血栓(deep vein thrombosis, DVT)的发生率及其影响因素,构建此类患者DVT风险预测模型。方法 采用回顾性研究设计,选取收治的脑卒中恢复期患者431例,通过单因素和多因素logistic回归分析筛选出DVT发生的影响因素,构建风险预测模型并用列线图展示,应用受试者工作特征(ROC)曲线下面积、敏感度、特异度评价模型的预测效果,使用Bootstrap法对模型进行内部验证。结果 431例患者中,有36例发生DVT,发生率为8.35%,建模组301例患者有26例发生DVT,发生率为8.64%,验证组130例患者有10例发生DVT,发生率为7.69%。Logistic回归分析显示MBI积分、Caprini血栓风险因素总分、平均血小板体积(MPV)、肌酐(Cr)、凝血酶时间(TT)、D-二聚体(D-Dimer)是脑卒中恢复期患者发生DVT的独立影响因素(OR值分别为0.978、1.186、0.662、0.979、1.043、1.766,均P<0.1)。以该6个因素为自变量构建列线图,建模组AUC为0.842,约登指数最大值为0.525,诊断值为0.115,敏感度为0.833,特异度为0.692;Hosmer-Lemeshow拟合优度检验χ^(2)=7.458,P=0.589。验证组AUC为0.720,约登指数最大值为0.425,诊断值为0.072,敏感度为0.675,特异度为0.700,Hosmer-Lemeshow拟合优度检验χ^(2)=11.414,P=0.248。结论 脑卒中恢复期患者DVT发生率较高,MBI积分、Caprini血栓风险因素总分、MPV、Cr、TT、D-Dimer是其重要的影响因素,构建的列线图可个性化预测脑卒中恢复期患者DVT发生风险,有助于医护人员制订相应的干预措施。

手术患者术后下肢深静脉血栓形成的术中预防方案分析

目的分析预防手术患者术后下肢深静脉血栓形成(LDVT)的术中应用方案。方法收集2022年3月至2023年2月于保定市第二中心医院收治的256例手术患者的临床资料,将2022年9月前未应用术中改良方案的患者作为常规组(n=119),将2022年9月开始应用术中改良方案的患者作为改良组(n=137)。比较两组患者的手术指标(手术时间、术中出血量、术后卧床时间、住院时间和配合度评分)、血流动力学指标(心率、平均动脉压)、手术前后股静脉血流指标(峰值血流速度、平均血流速度和血流量)、手术前后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)和D-二聚体(D-D)]及术后LDVT的发生情况。结果改良组患者的手术时间、术后卧床时间、住院时间均明显短于常规组患者,术中出血量明显少于常规组患者,配合度评分明显高于常规组患者,差异均有统计学意义(P﹤0.01)。入室后,两组患者的心率、平均动脉压比较,差异均无统计学意义(P﹥0.05);术中10 min、术毕即刻,改良组患者的心率、平均动脉压均低于常规组患者,差异均有统计学意义(P﹤0.05)。术后,改良组患者股静脉的峰值血流速度、平均血流速度、血流量均高于常规组患者,差异均有统计学意义(P﹤0.01)。术后,改良组患者的PT、APTT、TT均长于常规组患者,D-D、FIB水平均低于常规组患者,LDVT的发生率低于常规组患者,差异有统计学意义(P﹤0.05)。结论手术室人员于术中应用改良方案能够改善患者术中血流动力学,提高手术配合度,降低术中出血量,从而减轻术后血液高凝状态,促进术后下肢静脉血液回流,降低术后LDVT的发生风险。

中医护理预防髋关节置换术后下肢深静脉血栓的Meta分析

目的系统评价髋关节置换术后中医护理预防下肢深静脉血栓形成的临床效果。方法计算机检索PubMed、国家知识基础设施数据库(CNKI)、维普资讯中文期刊服务平台(VIP)、万方学术期刊全文数据库(Wanfang)中关于髋关节置换术后中医护理预防下肢深静脉血栓形成的文献,检索时间为2012—2022年11月。采用Cochrane干预措施系统评价手册(5.1.0版)偏倚风险评估工具对纳入的随机对照研究进行质量评价,运用RevMan5.4软件对纳入文献进行Meta分析。结果纳入11项研究,涉及1087例患者,其中研究组597例,对照组508例。Meta分析结果显示:中医护理下肢深静脉血栓发生率低于常规护理[RR=0.18,95%CI(0.09~0.35),Z=5.03,P<0.00001]。中医护理髋关节置换术后患者纤维蛋白原降低程度较常规护理明显[MD=-0.47,95%CI(-0.77~-0.16),Z=2.96,P=0.003],差异有统计学意义(P<0.05)。中医护理凝血酶原时间[MD=1.86,95%CI(-1.64~5.36),Z=1.04,P=0.30]、活化部分凝血活酶时间[MD=3.77,95%CI(-1.84~9.38),Z=1.32,P=0.19]与常规护理比较差异无统计学意义(P>0.05)。结论研究结果表明,髋关节置换术后,中医护理对预防下肢深静脉血栓形成有一定效果,且能显著降低纤维蛋白原,但在改善凝血酶原时间和活化部分凝血活酶时间方面,其效果与常规护理相比差异无统计学意义,受纳入范围和纳入研究质量的影响,上述结论尚待更多高质量的试验予以证实。