间歇充气加压对直肠癌术后凝血功能和下肢深静脉血流动力学的影响  

Effect of intermittent pneumatic compression on coagulation function and deep venon hemodynamics of lower limbs after rectal cancer resection

作　　者：王剑平[1] 林雨冬[1] 王烈[2] 徐方贵[1] 高远[1] 黎成金[2] 夏印[2] 朱建平[1] 吴仲秋[3] 

机构地区：[1]南京军区福州总医院九五临床部普通外科,福建莆田351100 [2]南京军区普通外科研究所南京军区福州总医院普通外科 [3]南京军区普通外科研究所南京军区福州总医院超声诊断科

出　　处：《中华胃肠外科杂志》2013年第8期739-743,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨间歇充气加压（IPC）对直肠癌患者术后凝血功能和下肢深静脉血流动力学的影响，以及对下肢深静脉血栓（DVT）的预防作用。方法将120例直肠癌根治手术患者按随机数字表法随机分为IPC组和对照组各60例，对照组按常规术后处理．IPC组在常规术后处理的基础上使用IPC。分别于术前及术后1、3、5和7d检测凝血酶原时间（PTT）、活化部分凝血活酶时间（APITr）、纤维蛋白原（FIB）、凝血酶原国际标准化值（INR）及血浆D一二聚体（D—D）含量；用彩色多普勒超声检查髂外、股及胭静脉管径和血流速度，计算平均血流速度（v）及血流量（Q）。结果对照组发生下肢DVT8例（13．3％），IPC组发生1例（1．7％），差异有统计学意义（P〈0．05）。两组患者术前frr、APTT、INR、FIB和D—D差异均无统计学意义（均P〉0．05）；术后1d，两组frr、APTT、INR与术前比较，差异均无统计学意义（均P〉0．05），而FIB和D．D较术前显著升高（P〈0．05），两组问差异无统计学意义（P〉0．05）。随着术后时间延长，两组PT逐步缩短（P〈0．05），APTr和INR均无显著变化（P〉0．05），FIB和D—D逐步升高（P〈0．05），但两组间差异无统计学意义（P〉O．05）。术后1、3、5和7d，对照组下肢深静脉平均血流速度及血流量均小于IPC组，差异均有统计学意义（均P〈0．05）。结论间歇充气加压能改善直肠癌术后患者下肢深静脉血流动力学指标，有效预防术后下肢DVT的发生，是一种安全而简便的物理疗法。Objective To investigate the effects of intermittent pneumatic compression （IPC） on coagulation function, deep venous hemodynamics and prevention of deep venous thrombosis （DVT） of lower limbs in patients after rectal cancer resection. Methods A total of 120 patients undergoing rectal cancer resection were randomly divided into non-IPC group （control group, n=60） and IPC group （n=60）. The control group received routine treatment after resection and the IPC group received IPC based on the routine treatments. Prothrombin time （ PT）, activated partial thromboplastin time （APTF）, fibrinogen （FIB）, international normalized ratio （INR） and volume of D-dimer（D-D） were detected before operation and 1-, 3-, 5- and 7-day after operation. Meanwhile, blood flow velocity and caliber of external iliac vein, femoral vein and popliteal vein were examined by color Doppler ultrasound, then the average blood flow velocity and blood flow volume were calculated. Results Incidence of lower limb DVT was 13.3% （8/60） and 1.7% （1/60） in control group and IPC group respectively with significant difference （P〈0.05）. The differences in PT, APTr and INR were not significant （P〉0.05） at 1-day afteroperation as compared to the preoperative level, while FIB and D-D both increased （P〈0.05）, all presented no significant difference among the two groups（P〉0.05）. PT shortened gradually（P〈0.05）, AFFF and INR did not change signifieantly（P〉0.05）, FIB and D-D increased gradually（P〈0.05）, and no significant differences were found between the two groups at the same time point （all P〉0.05 ）. All the above parameters in the control group were significantly lower than those in IPC group （all P〈0.05）. Conclusions IPC can improve hemodynamics indexes of deep veins of lower limb in patients after rectal cancer operation, and prevent the lower limb DVT. IPC is a safe, simple and convenient physical therapy.

关 键 词：直肠肿瘤 间歇充气加压 血流动力学 凝血功能 深静脉血栓 

分 类 号：R735.37[医药卫生—肿瘤]