间歇充气加压系统联合体位干预对胸腰椎骨折术后下肢静脉血流动力学及血栓形成的影响  

POSTURE INTERVENTIONWITH INTERMITTENT PNEUMATIC COMPRESSION SYSTEM ON VENOUS THROMBOSIS OF LOWER EXTREMITY AFTER THORACOLUMBAR FRACTURE

作　　者：马清华[1] 苏丹[1] 王瑞玲[1] Ma Qinghua;Su Dan;Wang Ruiling(The Third Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第三医院脊柱骨科,河北省石家庄市050000

出　　处：《中国煤炭工业医学杂志》2020年第5期549-552,共4页Chinese Journal of Coal Industry Medicine

基　　金：河北省卫生健康委员会医学科学研究课题(编号:20170670)。

摘　　要：目的观察胸腰椎骨折术后实施间歇充气加压泵联合体位干预对下肢静脉血流动力学及血栓形成的影响。方法回顾性分析2017年5月—2018年10月因胸腰椎骨折在该院行内固定术治疗的90例患者的临床资料,根据术后干预方法不同将其分为两组。观察组采用间歇充气加压泵联合体位干预,对照组采取常规措施。分别在术前、术后测定患者下肢静脉血流动力学和凝血功能各指标水平,记录下肢深静脉血栓(DVT)发生率、住院时间及术后下肢疼痛度情况。结果术后1 d、3 d、5 d时,观察组患者髂外静脉、股静脉及腘静脉的平均血流速度(Vm)、血流量(Q)均显著高于对照组(均P<0.05)。术后3d、5d时,观察组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及D二聚体(D-D)较术前显著降低(P<0.05);对照组只有D-D较术前有显著降低(P<0.05),且下降程度明显低于观察组(P<0.05)。观察组在术后下肢疼痛程度及住院时间上均显著低于对照组(P<0.05)。观察组DVT发生率为6.66%,对照组的发生率为20.00%,二组比较差异有统计学意义(P<0.05)。结论在胸腰椎骨折术后,对患者实施间歇充气加压泵联合体位干预的方法,可明显提高下肢静脉血液流动性,改善凝血功能,明显降低下肢血栓形成的风险。Objective To investigate the effect of bed tail elevation combined with intermittent pneumatic compression system on venous thrombosis of lower extremity after thoracolumbar fracture.Methods Ninety patients with thoracolumbar fractures underwent pedicle screw fixation in a hospital from May 2017 to October 2018 were retrospectively analyzed and patients were divided into two groups according to the different methods of postoperative intervention.The observation group was treated with compound intervention of intermittent pneumatic pressure pump,while the control group was treated with routine measures.The venous hemodynamics and coagulation function levels at different time point were measured separately.The incidence of deep venous thrombosis(DVT),hospital stay,and postoperative lower extremity pain were recorded.Results The blood flow velocity(Vm) and blood flow volume(Q) of the external iliac vein,femoral vein and iliac vein were significantly higher in the observation group than in the control group at different time point(P<0.05).At 3 and 5 days after operation,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB) and D-dimer(DD) in observation group were significantly lower than preoperative level(P<0.05).In the control group,only D-D was significantly lower than that before surgery(P<0.05),and the degree of decline was significantly lower than that of the observation group(P<0.05).The degree of lower extremity pain and hospitalization time in the observation group were significantly lower than those in the control group(P<0.05).The incidence of DVT was 6.66% in observation group was 6.66%,and 20.00% in control group(P<0.05).Conclusion After thoracolumbar fractures,bed tail elevation combined with intermittent pneumatic compression system can significantly improve the venous blood flow of the lower extremities,improve coagulation function,and significantly reduce the risk of lower extremity thrombosis.

关 键 词：间歇充气加压系统 体位干预 脊柱手术 血流动力学 深静脉血栓形成 

分 类 号：R683[医药卫生—骨科学]