【摘要】 [目的]探讨髋关节置换术后使用间歇充气加压装置(IPC)的最佳时间。[方法]选择2018年5月―12月在重庆医科大学附属第二医院行全髋关节置换术的病人42例,按照最小不平衡指数法随机分为对照组和观察组。两组病人均实施常规血栓预防管理措施。对照组常规使用IPC,每天1次,每次30 min;观察组使用IPC,每天2次,每次40 min。比较两组病人围术期的失血量和血栓发生率,分析两组病人术前及术后第3天、术后第5天的D-二聚体、纤维蛋白原、肢体周径的变化情况。[结果]两组病人均未发生症状性深静脉血栓形成(DVT),但对照组有6例(28. 57%)病人出现隐匿性下肢DVT,观察组2例(9. 52%)发生隐匿性下肢DVT,差异无统计学意义(P=0. 238)。两组病人总失血量比较差异无统计学意义(t=0. 704,P=0. 486),但观察组隐性失血量低于对照组(t=2. 739,P=0. 009)。经重复测量方差分析,时间效应、组别与时间的交互作用对纤维蛋白原的影响有统计学意义(F时间=27. 027,P<0. 001;F交互=3. 390,P=0. 044);分组效应、时间效应及组别与时间的交互作用对肢体周径的影响有统计学意义(F时间=6. 137,P=0. 022;F交互=24. 034,P<0. 001;F时间=18. 648,P<0. 001)。[结论]间歇加压治疗每天1次、每次30 min与每天2次、每次40 min均能预防DVT,但每天2次、每次40 min可有效降低出血量,改善血液高凝状态。更多还原

【Abstract】 Objective:To investigate the optimal time of intermittent pneumatic compression(IPC)after total hip arthroplasty(THA).Methods:Totally 42 patients undergoing THA were randomly divided into experimental group and control group according to the smallest imbalance index method. Both groups received routine thromboprophylaxis. The control group used IPC once a day each time for 30 minutes. While the experimental group was treated by IPC twice a day,with each time for 40 minutes. Perioperative blood loss,thrombosis rate were compared between the two groups,and the changes of D-Dimer,fibrinogen and the circumference of the lower leg were conducted before operation,3 days and 5 days after operation.Results:No incidence of symptomatic DVT was found in the study,while 6 cases(28. 57%)had asymptomatic DVT in the control group and 2 cases(9. 52%)in the experimental group respectively,there was no significant difference between the two groups(P=0. 238). There was no significant difference in total blood loss between the two groups(t=0. 704,P=0. 486). But the hidden blood loss in the experimental group was lower than that in the control group(t=2. 739,P=0. 009). Through repeated measurement variance analysis,the time effect and the interaction effect between treatment and time had statistically significant differences on fibrinogen(F=27. 027,P<0. 001;F=3. 390,P=0. 044). And the effects of treatment,time,interaction between time and treatment on the circumference of the lower leg were statistically significant(F=6. 137,P=0. 022;F=24. 034,P<0. 001;F=18. 648,P<0. 001).Conclusions:Using IPC once a day,with each time for 30 minutes or using IPC twice a day,with each time for 40 minutes,could both prevent the incidence of DVT,but twice a day,each time for 40 minutes was found to be more effective in reducing swelling and blood loss.更多还原