两种预防人工关节置换术后下肢深静脉血栓形成方案的临床评价  

Clinical Evaluation of Two Schemes for the Prevention of Deep Venous Thrombosis after Prosthetic Replacement of Joint

作　　者：罗旭[1] 刘洋[1] 简明[1] 李丹[1] 

机构地区：[1]武警湖南总队医院骨科,湖南长沙410006

出　　处：《医学临床研究》2011年第11期2040-2042,共3页Journal of Clinical Research

摘　　要：【目的】评价两种不同预防人工关节置换术后下肢深静脉血栓形成（DVT）方案的效果及安全性。【方法】40例人工膝、髋关节置换手术患者，随机分为两组，A组（n=19）予以术前12h使用低分子肝素（LMWH）4250IU，B组（n=21）则予以术后8h使用LMWH4250IU，两组均在麻醉开始时即应用间歇充气加压装置（IPC），LMWH、IPC连续使用至术后10d。对两组患者进行DVT症状评估、下肢深静脉的彩超及造影检查，观察出血并发症与记录围手术期出血量。【结果】围手术期出血量A组为（1039．6±287．5）mL，B组为（853．0±294．9）mL，两组比较差异有统计学意义（P〈0．05）；两组均无出血并发症，A组和B组各发生DVT1例，两组DVT发生率（5．26％VS4．76％）差异无统计学意义（P〉0．05）。【结论】两种DvT预防方案均能取得满意的治疗效果。但术后8h使用LMWH联合麻醉开始时即应用IPC的方案更为安全。[Objective] To evaluate the efficacy of two schemes for the prevention of deep venous thrombosis（DVT） after prosthetic replacement of joint. [Methods] Forty patients undergoing prosthetic replacement of joint and hip were randomly divided into two groups. Group A（ n = 19） was given 4250IU low-molecule-weight hepatin（LMWH） 12h before surgery, and group B（ n =21） was given 4250IU LMWH 8h after surgery. Intermittent pneumatic compression（fPC） was used at the beginning. of anesthesia. LMWH combined with IPC was used continuously until 10d after surgery. The evaluation of the symptoms of DVT, color Doppler ultrasonography and phlebography of deep vein of lower limbs of patients in two groups were undertaken. The bleeding complication was observed and the volume of blood loss during the operation was recorded. [Results] The volume of perioperative blood loss was （1039.6±287.5）mL and （853.0± 294.9）mL in group A and group B, respectively, and there was significant difference （ P 〈0.05）. No bleeding complication was found in both groups. DVT occurred in 2 cases in group A and group B with one case in each group, but there was no significant difference in the incidence of DVT between two groups（5.26 % vs 4.76 % ）（ P〉0.05）. [Conclusion] Both DVT schemes can obtain satisfactory treatment efficacy. LMWH 8h after surgery combined with IPC at the beginning of combined anesthesia is safer.

关 键 词：人工关节 血栓性静脉炎 

分 类 号：R543.6[医药卫生—心血管疾病]