止血带与驱血带联合使用对膝关节镜术后短期下肢静脉血栓形成的影响  

Effect of tourniquet combined with exsanguination band use on short-term lower extremity venous thrombosis after knee arthroscopy

作　　者：杨阳 李纳玺 张建[2] 王勉 龚泰芳[3] 辜刘伟 Yang Yang;Li Naxi;Zhang Jian;Wang Mian;Gong Taifang;Gu Liuwei(Postgraduate Training Basement of Jinzhou Medical University,Taihe Hospital(Affiliated Hospital of Hubei Medical College),Shiyan 442000,Hubei Province,China;Hubei Medical College,Shiyan 442000,Hubei Province,China;Department of Orthopedics,Joint and Sports Medicine,Taihe Hospital Affiliated to Hubei Medical College,Shiyan 442000,Hubei Province,China;Postgraduate Training Basement of Jinzhou Medical University,Shiyan People’s Hospital(Affiliated Hospital of Hubei Medical College),Shiyan 442000,Hubei Province,China)

机构地区：[1]锦州医科大学十堰市太和医院研究生培养基地(湖北医药学院附属医院),湖北省十堰市442000 [2]湖北医药学院,湖北省十堰市442000 [3]湖北医药学院附属太和医院骨关节与运动医学科,湖北省十堰市442000 [4]锦州医科大学十堰市人民医院研究生培养基地(湖北医药学院附属医院),湖北省十堰市442000

出　　处：《中国组织工程研究》2022年第6期898-903,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:膝关节镜术后下肢深静脉血栓的发生率在0.27%-17.5%之间,因此积极预防膝关节镜术后下肢静脉血栓的发生具有重要意义。目的:研究膝关节镜术中常规止血带下使用驱血带驱血对患者术后早期下肢静脉血栓发生率的影响。方法:纳入2019年6月至2020年12月在湖北医药学院附属太和医院行膝关节镜手术的患者200例,年龄40-60岁,根据术中是否使用驱血带驱血分为驱血带组(n=100)和抬腿驱血组(n=100),驱血后两组均使用加压止血带止血。术前1 d及术后1,3,7,14 d,检测两组患者血液凝血功能状态;术后2 d,利用彩色多普勒超声评估两组患者下肢静脉血栓发生情况;术后1,3,7 d,比较两组患者膝关节活动度。研究获得湖北医药学院附属太和医院伦理审批(医院伦理批件号:2021KS096)。结果与结论:(1)两组患者术后的血浆凝血酶原时间、活化部分凝血酶原时间、D-二聚体水平与术前相比均有不同程度增加;术后1,3,7 d,驱血带组患者的血浆凝血酶原时间、活化部分凝血酶原时间、D-二聚体水平较抬腿驱血组增加(P<0.05);术后14 d,两组患者3个指标检测结果比较差异无显著性意义(P>0.05)。(2)彩色多普勒超声检查显示,两组患者均未发生下肢深静脉血栓形成,但有较多下肢肌间静脉血栓发生,驱血带组患者的肌间静脉血栓发生率高于抬腿驱血组(28%,16%,P<0.05)。(3)两组患者术后的膝关节活动度比较差异无显著性意义(P>0.05)。(4)结果表明,止血带联合驱血带使用后可加重膝关节镜手术患者术后血液高凝状态,增加下肢肌间静脉血栓发生率及由此引起的继发性肺栓塞风险,但不会增加术后下肢深静脉血栓的发生率。BACKGROUND:The incidence of lower extremity deep venous thrombosis after knee arthroscopy is between 0.27%and 17.5%,so it is of great significance to actively prevent the occurrence of lower extremity deep venous thrombosis after knee arthroscopy.OBJECTIVE:To investigate the effect of using exsanguination band under routine tourniquet during knee arthroscopy on the incidence of lower extremity venous thrombosis in the early postoperative period.METHODS:Totally 200 patients between the ages of 40 and 60 years who underwent knee arthroscopic surgery in the Taihe Hospital of Hubei Medical College from June 2019 to December 2020 were included,including 100 patients in the driven blood band group and 100 patients in the leg raising driven blood group.Pressure tourniquet was used to stop bleeding in both groups after blood evacuation.Blood coagulation was detected in both groups 1 day before operation,1,3,7,and 14 days after operation.Color Doppler ultrasound of the lower extremity veins was performed 2 days after the operation to evaluate the occurrence of lower extremity vein thrombus.Motion range of the knee was compared between the two groups at 1,3,and 7 days after operation.This study was approved by the Taihe Hospital of Hubei Medical College(approval No.2021 KS096).RESULTS AND CONCLUSION:(1)Prothrombin time,activated partial thromboplastin time,and D-dimer level were increased after operation compared with those before operation in both groups.Prothrombin time,activated partial thromboplastin time,and D-dimer level were increased at 1,3 and 7 days postoperatively in the driven blood band group compared with the leg raising driven blood group(P<0.05).There was no significant difference between the two groups at 14 days postoperatively(P>0.05).(2)Color Doppler ultrasound examination showed that there was no deep venous thrombosis in the lower extremities between the two groups,but there were more intermuscular venous thrombosis in the lower extremities.The incidence of intermuscular venous thrombosis was higher i

关 键 词：止血带 驱血带 膝关节镜 下肢深静脉血栓 肌间静脉血栓 肺动脉栓塞 凝血功能 膝关节活动度 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]