人工膝关节置换术后药物抗凝空窗期使用间歇充气加压装置的安全性及成本效果分析  

Safety and cost-effectiveness analysis of using intermittent inflation and compression device during drug anticoagulation window period after artificial knee arthroplasty

作　　者：杨昌凤 何永琴 周媛媛 黄盈 赖淋雨 张玉梅 YANG Changfeng;HE Yongqin;ZHOU Yuanyuan;HUANG Ying;LAI Linyu;ZHANG Yumei(Department of Orthopedics,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China;Department of Ultrasonography,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院骨科,重庆400037 [2]陆军军医大学(第三军医大学)第二附属医院超声科,重庆400037

出　　处：《陆军军医大学学报》2023年第5期450-455,共6页Journal of Army Medical University

基　　金：陆军军医大学第二附属医院临床科研项目(2018YLC09)。

摘　　要：目的分析人工膝关节置换术(total knee arthroplasty,TKA)后药物抗凝空窗期使用间歇充气加压装置(intermittent pneumatic compression,IPC)的安全性及成本-效果。方法纳入行TKA手术的患者337例,采用随机数字表法进行分组,其中试验组168例,对照组169例。试验组在药物抗凝空窗期间双下肢持续使用IPC,对照组术后即刻至下床期间双下肢持续使用IPC,比较两组患者术后1 d肌间静脉丛血栓(muscular calf vein thrombosis,MCVT)的预防有效率、D2聚体水平、术后总失血量及成本-效果比的差异。结果2组患者术后1 d MCVT预防有效率、血红蛋白水平、总失血量、D2聚体水平比较,差异均无统计学意义;试验组IPC使用时间[6.00(6.00,6.00)h]较对照组[20.00(15.00,24.25)h]短,两组比较差异有统计学意义(P<0.01);试验组IPC使用总成本为172.84(172.84,172.84)元,与对照组[628.37(461.82,758.49)元]比较差异具有统计学意义(P<0.01);试验组的成本-效果比(2.23)小于对照组(7.75)。结论TKA术后药物抗凝空窗期使用IPC安全性好,较术后持续使用IPC具有更佳的成本效果。ObjectiveTo analyze the safety and cost-effectiveness of intermittent pneumatic compression(IPC)during the intermittent pneumatic interval after total knee arthroplasty(TKA).Methods A total of 337 patients who underwent TKA surgery were included and randomly divided into experimental group(n=168)and control group(n=169).The experimental group continued to use IPC for both lower limbs during the anticoagulant window period,while the control group continued to use IPC for both lower limbs immediately after surgery to the time of getting out of bed.Muscular calf vein thrombosis(MCVT)prevention rate,D2 polymer level,total postoperative blood loss,and cost-effectiveness ratio were compared between the 2 groups in 1 d after surgery.ResultsThere were no statistical significances in MCVT prevention effective rate,hemoglobin level,total blood loss,and D2 polymer level between the 2 groups in 1 d after surgery.The IPC time was 6.00(6.00,6.00)h in the experimental group,significantly shorter than that in the control group[20.00(15.00,24.25)h,P<0.01].The total cost of IPC was significantly lower in the experimental group than the control group[172.84(172.84,172.84)vs 628.37(461.82,758.49)Yuan,P<0.01].The cost-effectiveness ratio of the experimental group(2.23)was lower than that of the control group(7.75).ConclusionThe use of IPC during the anticoagulant window after TKA has good safety and better cost-effectiveness than the continuous use of IPC after surgery.

关 键 词：膝关节置换 肢体气压治疗 药物抗凝 药物空窗期 成本-效果 

分 类 号：R197.38[医药卫生—卫生事业管理] R473.6[医药卫生—公共卫生与预防医学] R687.4