急性下肢深静脉血栓形成早期下床活动与卧床治疗的前瞻性随机对照研究  

A randomized controlled prospective study on ambulation versus bed rest for the initial treatment of patients with acute deep venous thrombosis

作　　者：黄志军[1] 曲乐丰[1] 景在平[1] 刘傲飞[1] 袁良喜[1] 

机构地区：[1]上海第二军医大学附属长海医院血管外科,200433

出　　处：《中华普通外科杂志》2010年第9期737-739,共3页Chinese Journal of General Surgery

摘　　要：目的 比较急性下肢深静脉血栓形成（deep venous thrombosis,DVT）早期下床活动与卧床治疗疗效及并发肺梗死风险的差异.方法 将2008年02月至2009年03月收治的40例急性原发性DVT患者随机分为对照组和实验组,每组20例,均为发病7 d内入院治疗.对照组予卧床、弹力袜支持及患肢抬高治疗7～10 d 实验组予早期（入院后1～2 d）弹力袜支持下床行走（600～1200）m/d治疗7～10 d,两组均予正规抗凝及消肿辅助治疗,出院后继续抗凝治疗至少6个月.观察比较胀痛缓解[视觉模拟评分法,（visual analogue scale,VAS）]和患肢肿胀消退情况（患肢大腿周径变化值）,以及3个月中两组患者肺梗死的累计发生率.结果 两组患者症状体征均改善,对照组胀痛VAS值第5天（58±13）mm才下降到实验组第3天VAS值（58±8）mm的水平.治疗7 d后患肢大腿周径变化值的平均减小值,实验组为（2.9±0.9）cm,好于对照组的（1.5±0.8）cm,差异有统计学意义（t=3.335,P＜0.05）.两组3个月内均未发生症状性肺梗死.结论 初步研究结果提示急性下肢深静脉血栓形成早期下床活动治疗较卧床治疗患肢疼痛和肿胀的症状改善更明显,更快,生活质量明显提高,并没有增加肺梗死的发生率.Objective To evaluate the benefits and the risk of pulmonary embolism between walking exercises and bed rest in the acute stage of deep venous thrombosis （DVT）. Methods From February 2008 to March 2009,40 acute primary DVT patients were arbitrarily randomized into controlled group and experimental group,with 20 cases in each group,who were hospitalized within seven days of onset.Patients in controlled group underwent bed rest for 7-10 days,wearing elastic stockings.While patients in experimental group were early （1-2 days after admission） off bed walking about 600-1200 m every day with elastic stockings for 7-10 days.During the process patients in both group received regular anticoagulation treatment,and continued warfarin anticoagulation therapy after out of hospital for at least 6 months.The clinical characteristics of the two groups were comparable.Primary end points were the reduction of pain assessed daily with the Visual Analogue Scale （VAS）,the reduction of leg circumference at thigh,and cumulative pulmonary embolism incidences of two groups in three months. Results Symptoms in all patients of the two groups were improved,but the pain level showed a statistically significant reduction starting after the third day（58 ±8） mm in the experiment group and after the fifth day （58 ± 13） mm in the controlled group.The leg circumferences of the two groups after 7 days were statistically significantly different （P 〈 0.05）,the cumulative pulmonary embolism incidences of the two groups for 3 months were not statistically significantly different. Conclusion Mobile patients with acute DVT should be encouraged to walk with medical compression stockings.The rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression.The quality of life significantly improved.The risk of pulmonary embolism does not significantly increase by this approach.

关 键 词：静脉血栓形成 病例对照研究 早日下床活动 卧床休息 

分 类 号：R686[医药卫生—骨科学]