Prevention of the perioperative deep venous thrombosis in hip arthroplasty

doi:10.3969/j.issn.2095-4344.2017.31.002

Abstract

Abstract:

BACKGROUND: A meta-analysis of the clinical effectiveness of physical therapy combined with drugs versus single physical therapy or drugs for preventing deep venous thrombosis (DVT) has shown that combined therapy can effectively reduce the incidence of DVT.

OBJECTIVE: To explore the effective measures of the prevention of perioperative DVT in hip arthroplasty.

METHODS: This is a prospective study, 350 patients undergoing hip replacement were randomly divided into two groups, followed by given the treatment of intermittent pneumatic compression combined with standard dose of low-molecular-weight heparin (combination group), or only low-molecular-weight heparin (control group). The perioperative incidence of DVT was observed.

RESULTS AND CONCLUSION: (1) The incidence of DVT in the combination group was significantly lower than that in the control group (11% vs. 33.1%, P < 0.01). (2) No symptomatic pulmonary embolism was found in both groups. (3) To conclude, the anticoagulant prevention of DVT using the combination of intermittent pneumatic compression and standard dose of low-molecular-weight heparin is more effective than the use of low-molecular-weight heparin alone.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Hip Joint, Venous Thrombosis, Heparin, Tissue Engineering

CLC Number:

R318

Liu Jian-wei, Jiang Wei-ping. Prevention of the perioperative deep venous thrombosis in hip arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(31): 4927-4932.

Figures/Tables 3

2.3 两组患者髋关节置换后深静脉血栓形成发生情况低分子肝素联合间歇充气加压装置组深静脉血栓形成发生20例，发生率为11.4%。低分子肝素组患者发生深静脉血栓形成58例，发生率为33.1%。两组相比差异有显著性意义(P < 0.05)，两组患者均未发生肺栓塞等严重并发症。 2.4 两组患者深静脉血栓分布情况低分子肝素组58例深静脉血栓形成，包括髂股静脉血栓34例(19.4%)、腘静脉血栓13例(7.4%)及小腿静脉11例(占6.3%)。低分子肝素联合间歇充气加压装置组20例深静脉血栓形成，包括髂股静脉血栓13例(7.4%)、腘静脉血栓4例(2.3%)及小腿静脉3例(占1.7%)。低分子肝素联合间歇充气加压装置组总体深静脉血栓形成发生率、髂股静脉血栓、腘静脉血栓和小腿静脉血栓发生率均明显低于低分子肝素组，差异均有显著性意义(P < 0.01)，见表3。 2.5 髋关节置换后深静脉血栓形成处理髋关节置换后确诊深静脉血栓形成患者，即停用间歇充气加压装置，将低分子肝素使用治疗剂量100 AxaIU/kg进行抗凝。患者卧床、患肢制动，观察患肢肿胀消退情况，经治疗症状均好转，患肢肿胀消退，皮温正常。患者无症状性肺栓塞发生等严重并发症出现。 2.6 两组患者手术时间及关节置换后引流量比较低分子肝素联合间歇充气加压装置组手术时间平均为(90.0± 19.14) min，低分子肝素组平均为(86.9±17.09) min，两组比较差异无显著性意义(t=-1.374，P=0.183)。低分子肝素联合间歇充气加压装置组术中失血量平均为(378.55± 121.71) mL，低分子肝素组平均为(395.3± 106.34)mL，两组比较差异无显著性意义(t=0.613，P=0.574)。低分子肝素联合间歇充气加压装置组术后引流量平均为(258.63± 51.31)mL，低分子肝素组平均为(235.3± 36.45)mL，两组比较差异无显著性意义(t=0.425，P=0.321)。 2.7 不良反应低分子肝素组与低分子肝素联合间歇充气加压装置组术后均未发生消化道、颅内出血等出血事件。无血栓脱落造成局部栓塞肢体坏死、重要器官功能障碍、肺栓塞等并发症。 "

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