摘要
目的观察单纯应用压力梯度长袜(CS)或与间歇充气装置(IPC)联合使用预防恶性肿瘤患者术后下肢深静脉血栓(DVT)形成的效果及可能的机制。方法胸科、泌尿外科、肝胆外科恶性肿瘤根治手术患者240例,随机分为4组:对照组、单纯CS组、CS+IPC全程组、CS+IPC术后组,每组 60例。术后3-8 d内行双下肢深静脉超声检查,记录DVT例数及血栓发生部位(大腿或小腿)。随机选择对照组和CS+IPC全程组各15例患者,分别于术前、切皮后2 h及术后24 h各采集外周静脉血2 ml,测定D-二聚体(D-D)、纤溶酶原激活物抗原(tPA-Ag)、纤溶酶原激活物抑制物(PAI)、血管性血友病因子(vWF)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)。结果术后3-8 d对照组、CS+ IPC全程组、CS+IPC术后组和单纯CS组DVT发生率分别为49．3％、15．0％、23．3％和30．0％(P< 0．05)。所有发生DVT患者中,除CS组发现1例近端DVT外,其余均为远端DVT。发生DVT患者年龄、卧床时间、危险因素个数等与未发生血栓患者相比差异有统计学意义(P<0．05)。凝血/纤溶指标:与对照组比较,切皮后2 h,CS+IPC全程组vWF升高,D-D、tPA-Ag降低(P<0．05),术后24 h对照组和CS+IPC全程组间D-D、vWF、tPA-Ag及PAI差异无统计学意义。结论 CS+IPC全程或术后使用均能降低高危患者术后DVT的发生,其中CS+IPC全程使用预防效果最好,可能与IPC增加纤溶活性有关。
Objective To investigate the effects of graduated compression stocking （CS） alone or CS combined with intermittent pneumatic compression （IPC） on coagulation and fibrinolytic activity and the incidence of postoperative deep vein thrombosis （DVT） in patients undergoing major surgery. Methods Two hundred and forty ASA Ⅰ -Ⅳ patients undergoing major chest or abdominal surgery for malignant diseases were randomly assigned to one of four groups （ n = 60 each） ： group Ⅰ control; group Ⅱ CS alone; group m cs ＋ iPC1 and group Ⅳ CS ＋ IPC2. Patients less than 40 years of age and those on antieoagtdation therapy were excluded. In group Ⅱ , Ⅲ and Ⅳ the right size compression stockings were put on before operation in the operating room and taken off as soon as the patients resumed normal activity. In group Ⅲ and Ⅳ IPC system was started at skin incision （group m） or immediately after the patients being transferred to the ward or ICU （group Ⅳ ）. Pneumatic compression was maintained until the morning of the 1 st postoperative day. The patient＇s legs were then intermittently compressed for 2 hours at 2 h interval until the patients resumed ambulation. Deep vein ultrasound imaging of bilateral lower limbs was performed daily on the 3rd-8th day after operation for detection of DVT. The site of DVT and blood flow rate were determined. Blood samples were taken from 15 patients each in group Ⅰ and Ⅲ immediately before surgery （baseline, To ）, 2 h after skin incision （T1） and 24 h after operation （T2） for determination of plasma D-Dimer （D-D）, tissue type plasminogen activator antigen （tPA-Ag）, plasminogen activator inhibitor antigen （PAI-Ag）, von Willebrand factor （vWF）, APTT and prothrombin time （PT）. Results The four groups were comparable in terms of age, sex ratio, body weight, the number of risk factors （including senility 〉 60 yr, hypertension, diabetes mellitus, smoking, long term inactivity etc）, and duration of operation. The incidence of DVT was 49.3% in control group, 30.0% in group CS alone, 15 （P 〈 0.05）. There were significant differences in age, 0% in group CS＋ IPC1 and 23.3% in group CS＋ IPC2 number of risk factors and duration of bed rest between patients with and without postoperative DVT. Plasma vWF were higher and tPA-Ag, D-D were lower in group m than in control group （ Ⅰ ） at TI. There was no significant difference in plasma D-D, vWF, tPA-Ag and PAI-Ag between group Ⅰ and Ⅲ at T2 . Conclusion In high risk patients undergoing major surgery, CS combined with IPC can effectively prevent the development of postoperative DVT especially when IPC is started at the beginning of operation. Increased fibrinolytic activity may partly explain the mechanism.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第2期103-106,共4页
Chinese Journal of Anesthesiology
关键词
绷带
间歇性气体压缩装置
静脉血栓形成
手术后并发症
Bandages
Intermittent pneumatic compression devices
Venous thrombosis
Postoperative complications
