床尾抬高对腰椎内固定术后下肢深静脉血栓形成的影响与研究  

Effects of posture change on deep vein thrombosis of lower extremities in patients with lumbar degenerative disease after lumbar internal fixation surgery

作　　者：马清华[1,2] 苏丹 许微革[1] MA Qinghua;SU Dan;XU Weige(Department of Spinal Column Osteology,The Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院脊柱骨科,石家庄市050051 [2]国家广播电视总局机关服务局

出　　处：《河北医药》2020年第2期314-317,共4页Hebei Medical Journal

摘　　要：目的探讨床位抬高对腰椎内固定术后患者下肢深静脉血栓(deep vein thrombosis,DVT)形成的影响作用。方法因腰椎退行性疾病在我院接受腰椎内固定手术治疗的386例患者按照随机数字分组法将其分为观察组和对照组,每组193例,对照组给予常规康复指导及护理,观察组在常规康复护理的基础上进行床位抬高。采用彩色多普勒超声分别在手术前、后不同节点测定股静脉血流峰速度、平均速度、单位时间血流量,检测凝血指标变化情况,记录下肢深静脉血栓(DVT)发生率及住院患者满意度,并进行组间对比分析。结果术后2组患者股静脉血流峰速度、平均速度、单位时间血流量较术前均有明显降低,差异有统计学意义(P<0.05);术后不同时间点,对照组较观察组下降更为明显,组间比较差异有统计学意义(P<0.05)。术后1周时,观察组D二聚体(D-D)明显低于对照组,差异有统计学意义(P<0.05)。观察组DVT发生率为低于对照组,差异有统计学意义(P<0.05);2组患者满意度比较,差异无统计学意义(P>0.05)。结论对于腰椎内固定术后需要卧床的患者,床尾抬高能够明显增加下肢静脉血流速度并促进静脉内血液的回流,可显著降低下肢深静脉血栓的发生。Objective To investigate the effects of posture change on deep vein thrombosis(DVT)of lower extremities in patients with lumbar degenerative disease after lumbar internal fixation surgery.Methods A total of 386 patients with lumbar degenerative disease who underwent lumbar internal fixation surgery in our hospital were enrolled in the study,who were randomly assigned to observation group(n=193)and control group(n=193).The patients in control group were treated by conventional rehabilitation guidance and nursing care,however,the patients in observation group,on the basis of control group,were treated by elevation of the end of bed(10cm).The color Doppler ultrasonography was used to measure the peak velocity,mean velocity,and blood flow per unit time at different time point before and after surgery.Moreover the changes of coagulation parameters,and the incidence rate of deep venous thrombosis(DVT)as well as patient’s satisfaction degree were observed and compared between the two groups.Results After operation,the peak velocity,mean velocity and blood flow per unit time of the femoral vein were significantly decreased in both groups,as compared with those before operation(P<0.05),moreover,the decrease degree in different time points after operation in control group was more significant than that in observation group(P<0.05).At one week after operation,the D-dimer(D-D)levels in observation group were significantly lower than those in control group(P<0.05).In addition the incidence rate of DVT in observation group was 7.3%,which was significantly lower than that(16.6%)in control group(P<0.05).However there was no significant difference in patient’s satisfaction degree between observation group and control group(96.4%vs 93.3%P>0.05).Conclusion The posture change combined with general rehabilitation guidance and nursing care can promote venous blood back streaming of lower extremities and reduce the incidence rate of DVT in patients with lumbar degenerative disease after lumbar internal fixation surgery.

关 键 词：腰椎内固定术 床尾抬高 深静脉血栓 血流动力学 

分 类 号：R473.6[医药卫生—护理学]