围手术期干预对妇科盆腔手术后下肢深静脉血栓的预防作用

目的 探讨采取围手术期干预措施对妇科盆腔手术后下肢深静脉血栓(DVT)的预防作用.方法 将2007年6月至2008年6月于浙江大学医学院附属邵逸夫医院妇产科接受妇科盆腔手术的1062例患者分为干预组和非干预组.对干预组患者进行DVT危险因素评分,根据评分情况分为低、中、高和极高危4种类型,分别采取相应的围手术期干预措施.两组所有患者如术后7 d内出现下肢自发性疼痛、压痛和肿胀,腓肠肌压迫试验或直腿伸踝试验阳性,合并或存在单侧下肢浅表静脉扩张,立即行双下肢静脉彩色多普勒超声检查;干预组中高危和极高危患者于术后第2天和第7天常规行双下肢静脉彩色多普勒超声检查.比较两组患者的DVT发生率,以及手术前后的凝血和纤溶功能等.所有患者在术前1周内、术后48 h时分别检测凝血及纤溶功能.结果 干预组6例发生DVT,发生率为1.10%(6/546);非干预组17例发生DVT,发生率为3.29%(17/516);两组间DVT总发生率比较,差异有统计学意义(P<0.05).干预组中DVT极高危患者的DVT发生率为21.05%(4/19),均分别高于低危(0)、中危(0)、高危者[2.13%(2/94)],差异均有统计学意义(P<0.05).两组患者术后D二聚体及抗凝血酶Ⅲ水平均分别高于术前水平,但差异均无统计学意义(P>0.05).两组患者术后血小板计数、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间及纤维蛋白原、组织型纤溶酶原活化剂、纤溶酶原活化剂抑制剂水平分别比较,差异也均无统计学意义(P>0.05).结论 根据不同的DVT危险分群采取相应围手术期干预能显著降低DVT的发生率,建议加强对高危及极高危人群的DVT预防.

Perioperative intervention to prevent lower extremity deep venous thrombosis after gynecologic surgery

Objective To investigate the preventative effect of perioperative intervention to lower extremity deep venous thrombosis (DVT) after gynecologic surgery. Methods The 1062 patients, who received gynecologic surgery during 2007 June to 2008 June, were derided into intervention and nonintervention groups randomizely. According to the risk factors of DVT, the patients in intervention group were divided into 4 subgroups: low, mid, high and extremely high rise Each group had its own preventive measures. If patients had spontaneous pain, tenderness and swelling, positivity of Neuhof or Homan syndrome, and extension of one low extremity superficial vein, the low extremity color Doppler ultrasound would be carried out immediately. The ultrasound would also be routinely carried out in the high and extremely high risk groups in intervention group after 2 and 7 days after surgery. A prospective study was carried out investigating incidence of DVT and coagulation function perioperation. The vein blood samples were taken at in a week before surgery and 48 hours post-operation. Results The incidence of DVT of intervention group was 1.10% (6/546), and in nonintervention group, the incidence was 3.29% (17/ 516). There was significant difference between two groups (P<0.05). The incidence of DVT in extremely high risk subgroup was 21.05% (4/19), which was significantly higher than that of low(0), mid(0) and high risk groups[2.13% (2/94), P<0.05]. D-dimer, antithrombin-Ⅲ(AT-Ⅲ) post-operation were all higher than that pre-operation in the two groups, but there was no significant difference (P>0.05). The indexes of coagulation system, such as blood platelet count, prothrombin time (PT), active partial throraboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor(PAI), were not significantly changed perioperation (P>0.05 in all pre-or post-operation indexes). Conclusions Perioperative intervention measurement according to different risk of DVT could cut down the incidence of DVT. DVT preventive intervention is suggested to high and extremely high risk people.