低频脉冲与水蛭预防下肢骨折术后深静脉血栓形成的研究
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摘要
目的:探讨低频脉冲联合水蛭预防下肢骨折术后深静脉血栓形成的临床疗效。方法:选取2017年12月～2018年12月我院收治的90例下肢骨折手术患者,随机分为三组,每组30例,术后分别给予低分子肝素钠(对照组)、低分子肝素钠+水蛭(水蛭组)、低分子肝素钠+水蛭+低频脉冲(低频脉冲+水蛭组)预防血栓治疗。比较各组术前、术后的凝血功能、血流动力学、彩超检查结果、下肢消肿时间、不良反应及并发症发生情况。结果:对照组和水蛭组下肢肿胀开始消退时间分别为(5.2±1.4) d和(5.4±1.3) d,低频脉冲+水蛭组下肢肿胀开始消退时间为(3.6±0.9) d,低频脉冲+水蛭组下肢肿胀消退时间早于对照组和水蛭组(P<0.05);术后第7天低频脉冲+水蛭组股静脉血流速度快于对照组和水蛭组(P<0.05),对照组与水蛭组股静脉血流速度比较,差异无统计学意义(P>0.05);三组术后第7天PT、APTT均短于术前(P<0.05),但术后组间比较,差异无统计学意义;对照组2例术后发生下肢血栓,1例为肌间静脉血栓(未处理),另外1例为股静脉血栓(予介入治疗),余两组均无下肢深静脉血栓形成。所有患者最后顺利出院,治疗过程无明显药物不良反应及其他严重并发症发生。结论:低频脉冲联合水蛭能够安全、有效地预防下肢骨折术后深静脉血栓形成。
Objective: To explore the clinical effect of low fre quency pulse combined with leech in preventing deep venous thrombosis after lower limb fracture surgery. Methods: 90 Patients with lower extremity fracture were randomly divided into three groups,30 in each group. The control group was treated with low molecular weight heparin sodium, the leech group was treated with low molecular weight heparin sodium + leech,and the low frequency pulse + leech group was treated with low molecular weight heparin sodium+ leech + low frequency pulse. The coagulation function, hemodynamics, color doppler ultrasound results, the detumescence time of lower extremity, adverse reaction and complications were compared before and after operation. Result: The detumescence time of lower extremity in the control group and the leech group was(5.2+1.4) days and(5.4+1.3) days respectively. The detumescence time of lower extremity in the low frequency pulse + leech group was(3.6+0.9) days, which was significantly lower than that in other two groups(P<0.05). On the 7 th day after surgery, the blood flow velocity of femoral vein in the low frequency pulse + leech group was faster than other two groups(P<0.05), and there was no significant difference between the control group and the leech group(P>0.05). PT and APTT on the 7 th day after surgery in the three groups were shorter than those before surgery(P <0.05), however, the difference between three groups was not statistically significant. In the control group, 2 cases of lower extremity thrombosis occurred, 1 case was intramuscular venous thrombosis(untreated), 1 case was femoral vein thrombosis(interventional treatment), and the remaining two groups had no deep vein thrombosis of lower extremities. All patients were successfully discharged from the hospital, and there were no obvious adverse drug reactions and other serious complications during the treatment. Conclusion: The application of low frequency pulse combined with leech can safely and effectively prevent deep venous thrombosis after lower limb fracture surgery.
Objective: To explore the clinical effect of low fre quency pulse combined with leech in preventing deep venous thrombosis after lower limb fracture surgery. Methods: 90 Patients with lower extremity fracture were randomly divided into three groups,30 in each group. The control group was treated with low molecular weight heparin sodium, the leech group was treated with low molecular weight heparin sodium + leech,and the low frequency pulse + leech group was treated with low molecular weight heparin sodium+ leech + low frequency pulse. The coagulation function, hemodynamics, color doppler ultrasound results, the detumescence time of lower extremity, adverse reaction and complications were compared before and after operation. Result: The detumescence time of lower extremity in the control group and the leech group was(5.2+1.4) days and(5.4+1.3) days respectively. The detumescence time of lower extremity in the low frequency pulse + leech group was(3.6+0.9) days, which was significantly lower than that in other two groups(P<0.05). On the 7 th day after surgery, the blood flow velocity of femoral vein in the low frequency pulse + leech group was faster than other two groups(P<0.05), and there was no significant difference between the control group and the leech group(P>0.05). PT and APTT on the 7 th day after surgery in the three groups were shorter than those before surgery(P <0.05), however, the difference between three groups was not statistically significant. In the control group, 2 cases of lower extremity thrombosis occurred, 1 case was intramuscular venous thrombosis(untreated), 1 case was femoral vein thrombosis(interventional treatment), and the remaining two groups had no deep vein thrombosis of lower extremities. All patients were successfully discharged from the hospital, and there were no obvious adverse drug reactions and other serious complications during the treatment. Conclusion: The application of low frequency pulse combined with leech can safely and effectively prevent deep venous thrombosis after lower limb fracture surgery.
引文
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[8]Xia ZN,Zhou Q,Zhu W,et al.Low molecular weight heparin for the prevention of deep venous thrombosis after total knee arthroplasty:Asystematic review and meta-analysis[J].Int J Surg,2018,54(Pt A):265-275
[9]郭晓庆,孙佳明,张辉.水蛭的化学成分与药理作用[J].吉林中医药,2015,35(1):47-50
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[11]叶林,方钦正,董金波.低频脉冲电磁场联合唑来膦酸对骨质疏松性股骨粗隆骨折术后的影响[J].中国骨质疏松杂志,2018,24(7):914-917,948
[2]田伟.中国骨科大手术静脉血栓栓塞症预防指南(2016)[J].中华骨科杂志,2016,36(2):65-71
[3]Cannon KA,Badiee J,Wallace JD,et al.The prevalence of chronic deep venous thrombosis in trauma:Implications for hospitals and patients[J].J Trauma Acute Care Surg,2018,84(1):170-174
[4]Min SK,Kim YH,Joh JH,et al.Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis:Korean Practice Guidelines[J].Vasc Specialist Int,2016,32(3):77-104
[5]Paffrath T,Wafaisade A,Lefering R,et al.Venous thromboembolism after severe trauma:incidence,risk factors and outcome[J].Injury,2010,41(1):97-101
[6]Cervantes J,Rojas G.Virchow's Legacy:deep vein thrombosis and pulmonary embolism[J].World J Surg,2005,29(Suppl 1):S30-S34
[7]甘泉,赵文,马瑞鹏.低分子肝素钙与利伐沙班预防髋关节置换术后下肢深静脉血栓的比较研究[J].现代中西医结合杂志,2015,24(16):1751-1753
[8]Xia ZN,Zhou Q,Zhu W,et al.Low molecular weight heparin for the prevention of deep venous thrombosis after total knee arthroplasty:Asystematic review and meta-analysis[J].Int J Surg,2018,54(Pt A):265-275
[9]郭晓庆,孙佳明,张辉.水蛭的化学成分与药理作用[J].吉林中医药,2015,35(1):47-50
[10]杨波,康武林,李珣,等.水蛭在骨伤科的应用进展[J].西部中医药,2018,31(4):124-127
[11]叶林,方钦正,董金波.低频脉冲电磁场联合唑来膦酸对骨质疏松性股骨粗隆骨折术后的影响[J].中国骨质疏松杂志,2018,24(7):914-917,948