综合防治法预防人工髋关节置换术后静脉血栓栓塞

目的探讨人工髋关节置换术后静脉血栓栓塞的预防。方法2004年2月～2005年12月行人工全髋关节置换术43例、人工股骨头置换术26例。对所有患者均进行了由纤溶酶静脉滴注，踝关节主、被动“环转”运动及持续被动活动机（CPM）治疗等组成的静脉血栓栓塞综合防治。结果69例患者在观察期内均未出现下肢深静脉血栓栓塞及肺栓塞表现，二维彩色多普勒超声检查示静脉血流通畅。结论综合防治对于预防人工髋关节置换术围手术期静脉血栓栓塞的发生具有积极的临床意义。     

人工髋关节置换术后下肢深静脉血栓的预防及干预措施

目的探讨人工髋关节置换术后下肢深静脉血栓形成的预防及护理方法。方法对38例实施人工髋关节置换术的患者,从一般护理,到给予预防性早期功能锻炼、间歇性压力治疗等综合性护理措施,同时配合低分子肝素等抗凝药物治疗。结果38例患者经有效预防及护理措施,均未发生下肢深静脉血栓。结论对人工髋关节置换术后患者采取有效的预防及护理措施,可以避免下肢深静脉血栓的形成。     

人工全髋关节置换术102例围手术期护理

目的探讨人工全髋关节置换围手术期的护理经验,提高手术成功率。方法对102例进行人工全髋关节置换术患者围手术期的心理护理、术前护理、术后护理和适应性训练,预防并发症,指导患者正确使用助行器,并早期进行渐进式的康复功能锻炼。结果无1例患者发生感染和下肢静脉血栓并发症,均在术后12～15d出院。随防6个月至3年,所有病人术后髋关节疼痛症状明显缓解,对手术效果满意。结论术前积极治疗原发病,控制感染,给予良好的心理护理,术后密切观察病情变化,并积极预防并发症,提高病人生活质量,讲解功能锻炼的重要性是手术取得成功的重要因素,可使人工全髋关节置换术患者得到满意的康复效果。     

人工髋关节置换术后预防深静脉血栓的护理体会

目的:探讨人工髋关节置换术后深静脉血栓形成的预防及护理对策.方法:回顾性分析2007年到2010年我院收治的57例人工髋关节置换术患者的相关资料,分术前、术中、术后三阶段进行护理干预.结果:57例人工髋关节置换术患者,仅3例发生DVT,发生率为5.26%.结论:对人工髋关节置换术患者进行护理千预,能有效降低DVT的发生率.     

人工全髋关节置换术102例围手术期护理

目的探讨人工全髋关节置换围手术期的护理经验,提高手术成功率。方法对102例进行人工全髋关节置换术患者围手术期的心理护理、术前护理、术后护理和适应性训练,预防并发症,指导患者正确使用助行器,并早期进行渐进式的康复功能锻炼。结果无1例患者发生感染和下肢静脉血栓并发症,均在术后12～15d出院。随防6个月至3年,所有病人术后髋关节疼痛症状明显缓解,对手术效果满意。结论术前积极治疗原发病,控制感染,给予良好的心理护理,术后密切观察病情变化,并积极预防并发症．提高病人生活质量,讲解功能锻炼的重要性是手术取得成功的重要因素．可使人工全髋关节置换术患者得到满意的康复效果。     

人工髋关节置换术后的护理及康复指导

目的:探讨人工髋关节置换术后的护理及康复指导.方法:对60例人工髋关节置换术患者,从心理护理,术前准备到术后病情观察,术后并发症的预防,术后康复指导,给予全程护理干预.结果:60例患者均无严重护理并发症发生.结论:围手术期精心护理及康复指导能有效预防人工髋关节置换术后早期并发症发生.     

35例人工全髋关节置换围手术期护理体会

目的探讨人工全髋关节置换术围手术期护理配合。积极预防人工全髋关节置换术后并发症,帮助病人床上及床下功能锻炼方法。方法对35例人工全髋关节置换术患者的护理做回顾性总结。结论系统有效的人工全髋关节置换术围手术期护理积极地预防术后关节脱位、卧床并发症等,对提高手术效果、促进患者机体更好的恢复至关重要。     

人工髋关节置换术后感染的危险因素与预防

目的探讨人工髋关节置换术后感染的危险因素,提出有效的预防对策,为早期预防和控制人工髋关节置换术后感染提供依据。方法回顾性分析2004年1月-2012年12月在医院行人工髋关节置换术的992例患者临床资料,将发生感染的15例患者作为研究组,未发生感染的977例患者作为对照组,对比两组患者的临床资料,分析人工髋关节置换术后感染的危险因素及预防对策。结果 992例患者人工髋关节置换术后共发生感染15例,感染率为1.51%;检出病原菌15株,排前5位病原菌依次为金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌、表皮葡萄球菌、肺炎克雷伯菌,分别占33.33%、20.00%、20.00%、13.33%、6.67%;患者年龄、有基础疾病、合并糖尿病、有激素长期应用史、术前血清白蛋白及血红蛋白含量低、手术时间及引流时间是人工髋关节置换术后感染的危险因素(P<0.05)。结论人工髋关节置换术后感染的原因较多,与患者高龄、激素的长期应用、合并多种内科基础疾病等因素有关,根据高危因素有针对性的采取相应的预防对策,可降低感染发生率。     

髋关节置换术后下肢深静脉血栓的预防及护理

人工髋关节置换术是人体矫形外科中较大的重建手术.它主要适用于股骨颈骨骨折及股骨头坏死等患者.术后容易发生多种局部和全身并发症.现今,随着人工关节外科的不断发展和手术的日益普及,人工髋关节置换术后下肢深静脉血栓(以下简称DVT)已倍受人们关注[1-2].其发生率多达40%～60%,而近端DVT是肺栓塞的主要来源,致命的肺栓塞发生率为2%～3%,是全髋关节置换术病例中,术后早期死亡的主要原因之一.我科自2001年6月至2004年12月对收治的95例患者施行了髋关节置换术,笔者现将术后下肢静脉血栓的预防和护理报告如下.……     

人工髋关节置换术围手术期的护理干预方法探讨

目的探讨人工髋关节置换术围手术期的护理干预措施。方法对2010年4月-2011年12月期间笔者所在医院收治的20例接受人工髋关节置换术患者的临床护理资料进行回顾性分析。结果所有患者均在术后接受随访至少半年,最多两年以上,经X片复查显示所有患者的假体位置均变现为正常。其中包括3例高龄患者(年龄均超过70岁),在术后1月内均有发生脱位的情况,但经复位处理并特别嘱咐其注意事项后均再未见复发,未出现局部感染和下肢深静脉栓塞等并发症,Harris评分结果显示,术前平均为(46±11.7)分,而术后为(88±7.9)分。结论在人工髋关节置换术的围手术期,科学制定术前术后的各项护理措施,并在患者康复期间给予正确的并发症预防及功能锻炼指导和出院指导,是确保手术获得成功的重要因素。     

Patient ethnicity and use of venous thromboembolism prophylaxis.

OBJECTIVE: Patients at highest risk for developing venous thromboembolism include those undergoing major orthopedic surgery. However, physicians vary in their strategies to prevent venous thromboembolism. We evaluated whether the use of venous thromboembolism prophylaxis after orthopedic surgery is related to patient ethnicity. DESIGN: Retrospective cohort study, 1998-2002. SETTING: Tertiary care, university-affiliated hospital in Hawaii. STUDY PARTICIPANTS: 1811 adults (1085 women; 743 Asians; 206 Pacific Islanders; mean age 70.6 +/- 14.7 years) who underwent hip replacement, hip fracture surgery, or total knee replacement. MAIN OUTCOME MEASURES: Use of venous thromboembolism prophylaxis as recommended by the American College of Chest Physicians. Multivariable logistic regression was used to identify factors associated with prophylaxis use. RESULTS: Overall, 49.4% of patients received venous thromboembolism prophylaxis. After adjustment for patient age, sex, thromboembolism and bleeding risk factors, type of surgery, and anesthesia, Japanese patients were less likely to receive prophylaxis [odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5-0.9; P = 0.01], whereas other ethnic groups were treated similarly to whites. Relative to patients undergoing hip replacement, those with hip fracture surgery were less likely (OR = 0.4; 95% CI = 0.3-0.5; P < 0.01), and those receiving total knee replacement more likely (OR = 4.5; 95% CI = 3.6-5.7; P < 0.01) to receive appropriate prophylaxis. CONCLUSION: Despite consensus recommendations, venous thromboembolism prophylaxis use among high-risk patients remains low. Japanese patients and those undergoing hip fracture surgery are at particular risk for not receiving appropriate prophylaxis in our population. Further research is needed to clarify the reasons for our findings and to determine if this variation is associated with increased risk of thromboembolic complications.     

Cost-effectiveness of fondaparinux vs. enoxaparin as venous thromboembolism prophylaxis in Sweden

Deep-vein thrombosis and pulmonary embolism are important causes of morbidity and mortality among patients undergoing major surgery. Fondaparinux is a new antithrombotic agent for use in prophylaxis, and this study compared its cost and effect vs. enoxaparin as prophylactic treatment in patients undergoing total knee replacement, total hip replacement, or hip-fracture surgery in Sweden. The analyses were based on a simulation model. Swedish data on cost for deep-vein thrombosis and pulmonary embolism were obtained from a large sample of patients undergoing major orthopedic surgery. The relative risk reduction for treatment with fondaparinux was estimated from results of four recently published clinical trials. The base case analyses showed that fondaparinux was cost saving and more effective than enoxaparin after total knee replacement and hip-fracture surgery and had costs per prevented venous thromboembolism of about €239 after total hip replacement. Fondaparinux is thus more cost-effective than enoxaparin as prophylactic treatment in patients undergoing major surgery in Sweden.     

人工髋关节置换术后静脉血栓的预见性护理

目的:探索预见性护理干预对髋关节置换术后静脉血栓形成的影响。方法:将120例髋关节置换术病人随机分为观察组和对照组,每组60例,观察组采用预见性护理,对照组采用常规护理和健康教育。观察并比较两组病人术后静脉血栓发生情况。结果:观察组病人术后静脉血栓发生2例(3.33%),对照组9例(15.00%),观察组明显少于对照组(P<0.05)。结论:预见性护理干预能有效降低髋关节置换术后下肢静脉血栓的发生率。     

A study of thromboprophylactic practices of Scottish orthopaedic surgeons in patients undergoing total hip replacements. Should practice change with new guidelines?

Despite increasing scientific investigation, the best method for preventing postoperative thromboembolism in patients undergoing a total hip replacement (THR) remains unclear. National Institute for Health and Clinical Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the prevention of thromboembolism have caused much controversy. We surveyed Scottish surgeons regarding their thromboprophylaxis prescribing after THR. Questionnaires were sent to all Scottish orthopaedic consultants. They were asked about routine pharmacological and mechanical prophylaxis in patients undergoing a THR. Comparison was made with a previous survey done in 2003. The response rate was 75%. The survey showed an increased use of pharmacological prophylaxis from 93% to 100%. This was due to the increased use of aspirin from 51% to 64%. The use of low molecular weight heparin has remained constant at 51%. No surgeons routinely use warfarin, un-fractionated heparin or fondaparinux. Use of graded compression stockings has increased from 59% to 70%. In conclusion, there is increasing evidence that patients undergoing THR should receive extended prophylaxis for up to 35 days. Oral agents such as dabigatran and rivaroxaban have offered a new option for oral extended prescribing. The results in change of practice must be closely audited.     

Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery

A model was developed to estimate costs and clinical effectiveness of fondaparinux compared with enoxaparin after hip fracture surgery in Sweden. Outcomes and costs of venous thromboembolism (VTE)-related care from a health care perspective were incorporated, with symptomatic deep-vein thrombosis and pulmonary embolism, recurrent VTE, post-thrombotic syndrome, major haemorrhage and all-cause death being included. Event probabilities were derived from fondaparinux clinical trial data and published data. VTE-related resource use and associated costs as well as costs of prophylaxis were based on local Swedish data. Extended prophylaxis with fondaparinux could avoid an additional 28 symptomatic VTE per 1,000 patients compared with extended prophylaxis with enoxaparin in hip fracture surgery patients. Although the prophylaxis costs were higher in the fondaparinux group, these were offset by the lower costs associated with treating fewer VTE, which thus indicates that extended fondaparinux prophylaxis is the dominant alternative when compared with enoxaparin in hip fracture surgery.      

Thromboprophylaxis in patients undergoing total hip replacement

Venous thromboembolism is a common complication following a hip replacement. It was the authors' impression that prophylaxis of deep vein thrombosis has changed in recent years. The authors felt that it was important to repeat a survey, done in 1997, on the use of thromboembolism prophylaxis among British orthopaedic surgeons.