彩色多普勒超声在妇科术后下肢深静脉血栓预防中的作用  

Value of color Doppler ultrasonography in prevention of lower extremity deep venous thrombosis after gynecological surgery

作　　者：梁晓宁[1] 郭瑞君[1] 许涛[1] 翟俊修[1] 杨柏柳[2] 张震宇[2] 

机构地区：[1]首都医科大学附属北京朝阳医院超声医学科,北京100020 [2]首都医科大学附属北京朝阳医院妇产科,北京100020

出　　处：《中国医学影像技术》2009年第9期1624-1627,共4页Chinese Journal of Medical Imaging Technology

基　　金：国家"十一五"支撑计划项目(2006BAI01A06)

摘　　要：目的探讨彩色多普勒超声(CDU)在妇科手术后使用预防措施对下肢深静脉血栓(LEDVT)干预的价值。方法因妇科疾患接受盆腔手术的患者219例,根据患者并发LEDVT的风险程度随机分为三组:对照组:无预防措施;预防组分别使用下肢间歇性气囊加压(IPC)预防(IPC组)和低分子肝素(LMWH)预防(LMWH组)。应用彩色多普勒超声分别于术前1天、术后第二天开始扫查双下肢,若有血栓,则继续动态观察。结果LEDVT发生率对照组为11.64%,IPC组为4.11%,LMWH组为0.68%,预防组较对照组发生率显著下降(P<0.0001),IPC组与LMWH组间发生率差异无统计学意义(P=0.06);对照组高危患者中血栓发生的比例为42.86%,中危患者为5.88%,低危患者为8.00%;IPC组高危患者中血栓发生的比例为14.28%,中危患者为6.06%,低危患者无血栓发生;LMWH组中危患者中血栓发生的比例为2.94%,低危和高危患者无血栓发生;预防组高危患者中血栓发生的比例较对照组显著下降(P=0.01)。结论盆腔手术后下肢IPC及LMWH均可有效预防盆腔手术后LEDVT的发生,后者疗效更为显著;高危患者术后应常规使用预防措施;彩色多普勒超声在妇科手术后应用预防措施时有重要价值。Objective To observe the effectiveness of intermittent pneumatic compression（IPC） and low-molecular-weight heparin（LMWH） medication for the prevention of lower extremity deep vein thrombosis（LEDVT） with color Doppler ultrasonography after gynecological pelvic surgeries.Metheds A total of 219 patients who received pelvic surgery because of gynecopathy were divided into 3 groups randomly according to the risk levels for thrombo-embolism：group A with no prevention strategy as control group;prevention group：group B using IPC to prevent LEDVT and group C using LMWH to prevent LEDVT.Color Doppler ultrasonography was performed to scan the lower extremities 1 day before operation and 2 days after operation.Dynamic observation was continued if there was thrombosis.Rusults The morbidity of LEDVT was 11.64% in group A,4.11% in group B and 0.68% in group C,morbidity in group with prevention reduced obviously than that in group without prevention（P〈0.0001）;there was no difference between group B and C（P=0.06）.The DVT ratio of high risk cases in group A was 42.86%,moderate risk cases was 5.88% and low risk cases was 8.00%;the DVT ratio of high risk cases in group B was 14.28%,moderate risk cases was 6.06% and no DVT was found in low risk cases.DVT ratio of moderate risk cases in group C was 2.94%,none in low risk and high risk cases;DVT ratio of high risk cases in prevention group reduced obviously than that in control group（P=0.01）.Conclusion The mobidity of postoperative LEDVT in gynecological surgeries was 11.46% with no positive prevention.Both IPC and LMWH can effectively prevent LEDVT after pelvic surgery,and the latter is more effective.IPC and LMWH should be used in prevention treatment routinely on high risk postoperative patients.

关 键 词：超声检查 多普勒 彩色 静脉血栓 下肢 妇科手术 预防和控制 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]