A randomized controlled trial of different physical methods for preventing deep venous thrombosis of lower extremities after pelvic fracture operation
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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。Abstract: 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.
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