不同物理方法预防骨盆骨折术后下肢深静脉血栓的随机对照研究
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摘要
目的探讨在使用药物抗凝的基础上联合使用不同物理方法:间歇充气加压装置(intermittent pneumatic compression,IPC)、穿戴梯度弹力袜(graduated compression stockings,GCS)和IPC+GCS,预防骨盆骨折术后下肢深静脉血栓(deep vein thrombosis,DVT)的临床疗效。方法选取2013年1月—2017年6月浙江省人民医院收治的210例患者纳入前瞻性随机对照研究,按随机数字表法分为IPC组、GCS组与联合预防组各70例,入院后IPC组患者采用抗凝药物联合IPC抗凝治疗,GCS组患者采用抗凝药物联合穿戴梯度弹力袜抗凝治疗,联合预防组患者采用药物联合IPC+GCS抗凝治疗预防DVT。术前1 d、术后24 h、术后第7天分别检测并记录3组血浆D-二聚体(D-dimer,D-D)浓度和行下肢彩色多普勒超声检查,明确有无DVT的发生。对怀疑肺栓塞的患者行CT肺动脉造影检查明确诊断。结果术后第7天联合预防组与IPC组、GCS组之间总DVT和肌间DVT发生率、血浆D-D浓度比较差异均有统计学意义(均P<0.05)。3组患者近端DVT、远端DVT发生率比较差异均无统计学意义(均P>0.05)。结论在使用药物抗凝的基础上联合使用IPC+GCS与单独使用IPC或GCS抗凝治疗相比能够显著降低骨盆骨折术后早期血浆D-D浓度和下肢肌间DVT的发生率。
Objective To explore the clinical efficacy of anticoagulant combined with intermittent pneumatic compression(IPC) device and graduated compression stockings(GCS) on preventing deep venous thrombosis(DVT) of lower extremities.Methods From January 2013 to June 2017,210 patients were enrolled in the prospective randomized controlled study,and assigned into IPC group,GCS group and the combination group(IPC + GCS) with 70 patients in each group.The patients of the three groups were administrated with anticoagulant.And the patients in IPC group were managed with intermittent pneumatic compression,the patients in the GCS group with graduated compression stockings,and the combination group with IPC + GCS.On the first day before the operation,the second and seventh day after the operation,the levels of plasma D-dimer were tested,and color Doppler ultrasonography was performed for DVT.CT pulmonary angiography was conducted on patients suspected of pulmonary embolism for confirming the diagnosis.Results On 7th days after the operation,the difference between in the incidence of total DVT,intramuscular DVT and plasma D-dimer levels among the three groups were statistically significant(all P < 0.05).There was no significant difference in the incidence of proximal DVT and distal DVT among the three groups(all P > 0.05).Conclusion On the basis of using anticoagulation,when compared with IPC or GCS alone,the combining use of IPC and GCS can significantly reduce the plasma concentration of D-dimer and the incidence of calf intermuscular DVT after pelvic fracture.
Objective To explore the clinical efficacy of anticoagulant combined with intermittent pneumatic compression(IPC) device and graduated compression stockings(GCS) on preventing deep venous thrombosis(DVT) of lower extremities.Methods From January 2013 to June 2017,210 patients were enrolled in the prospective randomized controlled study,and assigned into IPC group,GCS group and the combination group(IPC + GCS) with 70 patients in each group.The patients of the three groups were administrated with anticoagulant.And the patients in IPC group were managed with intermittent pneumatic compression,the patients in the GCS group with graduated compression stockings,and the combination group with IPC + GCS.On the first day before the operation,the second and seventh day after the operation,the levels of plasma D-dimer were tested,and color Doppler ultrasonography was performed for DVT.CT pulmonary angiography was conducted on patients suspected of pulmonary embolism for confirming the diagnosis.Results On 7th days after the operation,the difference between in the incidence of total DVT,intramuscular DVT and plasma D-dimer levels among the three groups were statistically significant(all P < 0.05).There was no significant difference in the incidence of proximal DVT and distal DVT among the three groups(all P > 0.05).Conclusion On the basis of using anticoagulation,when compared with IPC or GCS alone,the combining use of IPC and GCS can significantly reduce the plasma concentration of D-dimer and the incidence of calf intermuscular DVT after pelvic fracture.
引文
[1]杨帆,王满宜,刘亚波,等.Pilon骨折急诊外固定支架固定对深静脉血栓形成的影响[J].中华创伤骨科杂志,2015,17(6):474.
[2]侯伟,熊小明,万趸.骨盆骨折内固定术中应用普通肝素对术后下肢深静脉血栓发生率的影响[J].四川医学,2015,36(7):996.
[3]李锡生,王殷红,何亚萍,等.髋臼及骨盆骨折患者术前深静脉血栓形成的影响因素[J].中国现代医生,2014,52(5):4-7.
[4]赵宇驰,张树栋,于明伟,等.药物联合间歇充气加压装置预防关节置换术后下肢深静脉血栓的随机对照研究[J].中华骨科杂志,2015,35(11):1091-1094.
[5]严美娟,楼小侃,吴佳.低分子肝素预防合并糖尿病的腹腔镜手术患者围手术期静脉血栓形成的效果[J].中华全科医学,2016,14(9):1449.
[6]丁冠男,李树人,潘振祥,等.巴曲亭对低分子肝素抗凝全髋置换术患者出血量及凝血功能影响的研究[J].中华流行病学杂志,2014,36(6):737-740.
[7]林素云.低分子肝素钙预防妇科肿瘤术后深静脉血栓的效果观察[J].中华全科医学,2015,13(11):1905.
[8]臧加成,马信龙,马剑雄,等.不同部位骨折深静脉血栓发生率的流行病学研究[J].中华骨科杂志,2016,36(9):543.
[9]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
[10]中华医学会骨科学分会创伤骨科学组.创伤骨科患者深静脉血栓形成筛查与治疗的专家共识[J].中华创伤骨科杂志,2013,15(12):1013-1017.
[11]王勇.人工关节置换术后两种预防深静脉血栓方法的对比分析[J].长江大学学报(自科版),2015,12(12):36-38.
[12]孙永新.探索骨盆创伤性肢体静脉血栓形成的原因[J].中国医药指南,2015,13(18):167-168.
[13]邓淼,杨渝勇,曹国永,等.下肢创伤后深静脉血栓形成的危险因素及其与D-二聚体的相关性[J].武警医学,2014,25(5):475-477.
[14]刘丹,陈嘉,刘立群.医用弹力袜联合充气压力泵预防老年重症下肢深静脉血栓效果的Meta分析[J].中国老年学杂志,2016,36(16):4035-4036.
[15]谢煜,张成欢,刘云,等.机械装置预防深静脉血栓形成依从性:基于观察性研究的Meta分析[J].中国组织工程研究,2016,20(35):5305-5311.
[16]杨军,董宝军,张福江,等.血栓弹力图、D-二聚体预测骨科大手术围手术期抗凝治疗终点并发DVT的诊断价值[J].中华骨科杂志,2015,35(8):804-806.
[17]赵伯翔,顾建平,陈国平,等.D-二聚体监测在治疗急性髂股静脉血栓形成中的临床价值[J].介入放射学杂志,2013,22(6):464-469.
[18]MASUDA M,UETA T,SHIBA K,et al.D-dimer screening for deep venous thrombosis in traumatic cervical spinal injuries[J].Spine J,2015,15(11):2338-2344.
[19]杨志华,李青,冯健,等.脊柱退行性变患者围手术期D-二聚体的变化及其对深静脉血栓栓塞症的预测价值[J].中华全科医学,2017,15(4):585.
[20]付亚辉,王鹏飞,王宝辉,等.老年髋部骨折患者围手术期深静脉血栓形成的发生规律及血浆D-二聚体的变化特点[J].中华创伤骨科志,2016,18(8):671.
[2]侯伟,熊小明,万趸.骨盆骨折内固定术中应用普通肝素对术后下肢深静脉血栓发生率的影响[J].四川医学,2015,36(7):996.
[3]李锡生,王殷红,何亚萍,等.髋臼及骨盆骨折患者术前深静脉血栓形成的影响因素[J].中国现代医生,2014,52(5):4-7.
[4]赵宇驰,张树栋,于明伟,等.药物联合间歇充气加压装置预防关节置换术后下肢深静脉血栓的随机对照研究[J].中华骨科杂志,2015,35(11):1091-1094.
[5]严美娟,楼小侃,吴佳.低分子肝素预防合并糖尿病的腹腔镜手术患者围手术期静脉血栓形成的效果[J].中华全科医学,2016,14(9):1449.
[6]丁冠男,李树人,潘振祥,等.巴曲亭对低分子肝素抗凝全髋置换术患者出血量及凝血功能影响的研究[J].中华流行病学杂志,2014,36(6):737-740.
[7]林素云.低分子肝素钙预防妇科肿瘤术后深静脉血栓的效果观察[J].中华全科医学,2015,13(11):1905.
[8]臧加成,马信龙,马剑雄,等.不同部位骨折深静脉血栓发生率的流行病学研究[J].中华骨科杂志,2016,36(9):543.
[9]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
[10]中华医学会骨科学分会创伤骨科学组.创伤骨科患者深静脉血栓形成筛查与治疗的专家共识[J].中华创伤骨科杂志,2013,15(12):1013-1017.
[11]王勇.人工关节置换术后两种预防深静脉血栓方法的对比分析[J].长江大学学报(自科版),2015,12(12):36-38.
[12]孙永新.探索骨盆创伤性肢体静脉血栓形成的原因[J].中国医药指南,2015,13(18):167-168.
[13]邓淼,杨渝勇,曹国永,等.下肢创伤后深静脉血栓形成的危险因素及其与D-二聚体的相关性[J].武警医学,2014,25(5):475-477.
[14]刘丹,陈嘉,刘立群.医用弹力袜联合充气压力泵预防老年重症下肢深静脉血栓效果的Meta分析[J].中国老年学杂志,2016,36(16):4035-4036.
[15]谢煜,张成欢,刘云,等.机械装置预防深静脉血栓形成依从性:基于观察性研究的Meta分析[J].中国组织工程研究,2016,20(35):5305-5311.
[16]杨军,董宝军,张福江,等.血栓弹力图、D-二聚体预测骨科大手术围手术期抗凝治疗终点并发DVT的诊断价值[J].中华骨科杂志,2015,35(8):804-806.
[17]赵伯翔,顾建平,陈国平,等.D-二聚体监测在治疗急性髂股静脉血栓形成中的临床价值[J].介入放射学杂志,2013,22(6):464-469.
[18]MASUDA M,UETA T,SHIBA K,et al.D-dimer screening for deep venous thrombosis in traumatic cervical spinal injuries[J].Spine J,2015,15(11):2338-2344.
[19]杨志华,李青,冯健,等.脊柱退行性变患者围手术期D-二聚体的变化及其对深静脉血栓栓塞症的预测价值[J].中华全科医学,2017,15(4):585.
[20]付亚辉,王鹏飞,王宝辉,等.老年髋部骨折患者围手术期深静脉血栓形成的发生规律及血浆D-二聚体的变化特点[J].中华创伤骨科志,2016,18(8):671.