探讨髋关节置换术后下肢深静脉血栓形成的危险因素及对策

目的 探讨髋关节置换术后下肢DVT的危险因素及预防措施.方法 收集2014年6月至2016年6月在本科住院并接受髋关节置换患者78例,根据术后是否发生下肢DVT分为血栓组和无血栓组,选择性别、年龄、冠心病、高血压、体重指数、肥胖、手术时间、卧床时间＞7d等可能影响下肢DVT的因素对两组患者进行比较,通过单因素和多因素Logistic回归分析,得出髋关节置换术后下肢DVT的危险因素.结果 单因素分析两组患者在年龄＞60岁、高血压、手术时间、卧床时间＞7d方面差异有统计学意义(P＜0.05);多因素Logistic回归分析,年龄年龄＞60岁、高血压、卧床时间＞7d为髋关节置换术后下肢DVT形成的重要危险因素,应重点关注.结论 年龄＞60岁、高血压、卧床时间＞7d为髋关节置换术后下肢DVT形成的重要危险因素,尽早采取预防措施,对于预防下肢DVT的发生,具有重要意义.     

老年髋关节置换术后下肢深静脉血栓发生情况及其影响因素

目的：探讨老年髋关节置换术后下肢深静脉血栓(DVT)发生情况及其影响因素。方法：采用随机试验方法,选取2016-01～2020-04于我院接受髋关节置换术治疗的250例老年患者作为研究对象,观察患者术后7d DVT发生情况,并收集患者基线资料,分析可能导致老年髋关节置换术后发生DVT的影响因素。结果：术后7d, 250例患者中29例患者发生DVT,DVT发生率为11.60%,发生DVT组体质量指数(BMI)≥24kg/m²、术后卧床时间≥3d、合并糖尿病、全麻占比未发生DVT组高,差异有统计学意义(P<0.05);Logistic回归分析结果显示,BMI≥24kg/m²、术后卧床时间≥3d、合并糖尿病、全麻均为老年髋关节置换术后发生DVT的影响因素(OR>1,P<0.05)。结论：BMI≥24kg/m²、术后卧床时间≥3d、合并糖尿病、全麻均为老年髋关节置换术后发生DVT的影响因素。     

老年髋关节置换术后下肢深静脉血栓形成的危险因素分析

目的分析老年髋关节置换术后下肢深静脉血栓形成的危险因素。方法分析2016年4月—2018年6月于上饶市广丰区人民医院行髋关节置换术的284例患者临床相关资料,统计老年髋关节置换术后下肢深静脉血栓形成率,采用多因素Logistic回归分析老年髋关节置换术后下肢深静脉血栓形成的危险因素。结果老年髋关节置换术后下肢深静脉血栓形成率为25.35%。老年髋关节置换术后下肢深静脉血栓形成与年龄、吸烟史、高血压史、糖尿病史、心房颤动史、术中失血量、体质指数、术前合并下肢静脉病变、术后卧床时间、术后下肢机械性辅助锻炼、合并血液高凝及肺部感染密切相关(P<0.05)。经多因素Logistic回归分析结果显示,患者年龄大、合并高血压史、合并心房颤动史、术中失血量>500 ml、术前合并下肢静脉病变、术后卧床时间>4 d、术后未进行下肢机械性辅助锻炼、合并血液高凝及合并肺部感染均是诱发老年髋关节置换术后下肢深静脉血栓形成的独立危险因素(OR>1,P<0.05)。结论老年髋关节置换术后引发下肢深静脉血栓形成的危险因素较多,临床上应结合患者具体情况采取相应的处理措施,以预防下肢深静脉血栓形成。     

影响人工关节置换术后深静脉血栓形成相关因素的探讨

目的 探讨影响人工关节置换术后下肢深静脉血栓(DVT)形成的临床风险因素.方法 单侧人工髋、膝关节置换术患者儿111例,术后3～13 d行双下肢上行性静脉造影,检查深静脉血流通畅情况及DVT发生情况;对13项临床因素与人工关节置换术后DVT形成的相关性进行分析.结果 人工关节置换术后DVT总发生率为31.5% ,其中全髋关节置换术(THR)25.3% ,全膝关节置换术(TKR)50.0% ;未见症状型肺栓塞患者.结论 术后DVT发生率与关节置换种类有关,TKR高于THR.     

全髋关节置换术后DVT的临床预防及护理方法探讨

目的探讨全髋关节置换术后DVT形成的临床预防及护理干预方法。方法选取我院骨科2008年6月至2011年8月行全髋关节置换术的患者68例作为观察组,进行DVT危险因素评估并实施术后护理,同时选取2004年7月至2008年5月行全髋关节置换术术后未进行DVT危险因素评估并实施术后护理的患者68例作为对照组进行对比分析。结果研究组术后DVT症状和体征及其发生率明显低于对照组,两组对比差异具有统计学意义(P<0.05)。结论全髋关节置换术后采用有效护理干预可有效预防术后下肢深静脉血栓形成的发生,改善患者的预后,从而提高患者生活质量。     

全髋关节置换术后深静脉血栓形成的危险因素分析

目的 探讨全髋关节置换术(THR)后易发生下肢深静脉血栓(DVT)形成的危险因素.方法 对145例患者均于手术前及术后第7天分别行双下肢彩色多普勒超声检查,明确是否有下肢DVT形成.将DVT发生与否作为因变量,把临床可疑因素作为自变量,先进行单因素分析,得出有显著差异性的因素,再进行多因素非条件logistic分析,筛选出DVT发生的主要影响因素.结果 发生DVT45例,发生率31%.高龄、女性、双侧THR、全身麻醉、使用骨水泥等与DVT形成显著相关(P<0.05).其中,性别、肥胖及骨水泥的使用,其术后发生DVT的风险倍数分别增加到10.012、3.086和8.834;保护因素1个,为术前患者血型是O型,术后发生DVT的可能性减少到0.191倍.结论 THR患者术后发生DVT常存在多个危险因素.     

低分子肝素联合物理方法预防老年髋关节置换围术期下肢深静脉血栓形成的效果观察

目的 观察低分子肝素联合物理方法预防老年髋关节周围骨折行髋关节置换围术期下肢深静脉血栓(DVT)形成的效果。 方法 回顾性选取平煤神马医疗集团总医院2015年10月至2016年10月收治的140例行全髋关节置换术老年髋关节周围骨折患者临床资料,采用随机数字表法分为观察组和对照组,每组70例。对照组采用物理疗法预防DVT,观察组在此基础上给予低分子肝素或利伐沙班进行预防,比较两组术后DVT发生率、DVT相关症状发生情况、动态监测凝血功能指标[D-二聚体、纤维蛋白原(FIB)、活化部分凝血活酶时间(ATPP)],随访髋关节Harris评分和生活质量(QOL)评分情况。 结果 观察组DVT发生率8.57%明显低于对照组的21.43%(P＜0.05);术后1 d、7 d观察组髌上15 cm、髌下10 cm、踝上5 cm肢体周径与对照组差异无统计学意义(均P＞0.05),术后3 d观察组不同部位肢体周径明显低于对照组(P＜0.05);术后1 d、3 d观察组不同部位肢体体表皮温均低于对照组(P＜0.05);观察组Homan征、Nenhof征阳性率分别为4.29%、4.29%均明显低于对照组的11.43%、10.00%(均P＞0.05);两组患者术前、术后1 d、术后3 d D-二聚体、FIB、ATPP水平基本相近(均P＞0.05),术后7 d观察组D-二聚体、FBI水平明显低于对照组、APTT水平明显高于对照组,经组间t检验均P＜0.05;DVT组和无DVT组患者术后1个月、3个月、6个月Harris评分、QOL评分均明显高于术前(P＜0.05),且术后各时点DVT组两项评分均明显高于无DVT组评分(均P＜0.05)。 结论 低分子肝素联合常规物理预防措施可有效预防老年髋关节周围骨折行全髋关节置换术患者DVT,促进术后髋关节功能恢复,改善其生存质量,可作为防治DVT的首选方案。     

快速康复外科理念在预防老年人工髋关节置换术后下肢深静脉血栓形成的应用价值

目的:探讨快速康复外科(FTS)理念在预防老年人工髋关节置换术后下肢深静脉血栓(DVT)形成的应用价值。方法:选取某院收治的72例人工髋关节置换患者为研究对象,病例来自2015年3月~2017年3月,利用随机双盲法将其分为观察组(36例)和对照组(36例),对照组患者实施常规围手术期护理,观察组在对照组的基础上应用快速外科康复理念进行围手术期护理,比较两组患者下肢深静脉血栓发生率和髋关节功能恢复情况。结果:观察组患者下肢深静脉血栓发生率及术后4个月的Harris髋关节功能评分均明显优于对照组,P0.05。结论:快速康复外科理念对预防老年人工髋关节置换术后下肢深静脉血栓的形成具有积极效果,还能促进患者髋关节功能的恢复。     

人工髋关节置换与下肢深静脉血栓的关系分析

目的分析人工髋关节置换术后,患者出现下肢深静脉血栓(DVT)的影响因素。方法选取我院2010年2月至2012年1月收治92例进行髋关节置换手术的患者作为观察对象,全部患者于术前7 d及术后7 d行血管彩超(双下肢),分析年龄、性别、BMI、激素应用、TG、糖尿病、高血压等15项因素与术后DVT发生的相关性。结果血管彩超结果显示,92例患者中,28例患者于术后发现DVT(30.43%),血栓均分布在患者小腿肌间。其中,13例患者(46.43%)无相关临床症状。女性、肥胖、高龄、O型血、高血压、糖尿病、总输血量大、胆固醇及三酰甘油高是DVT发生的危险因素,RR值>1。其中,患者年龄>65岁,大量输血,TG水平高(≥1.7 mmol/L)与DVT发生密切相关,P<0.05,具统计学意义。结论患者年龄>65岁,大量输血、TG水平高是诱发术后DVT的重要因素。因此,在髋关节置换术后,我们应严格控制患者输血量;若患者需要大量输血,我们可采用少量多次的方法补充血液;此外,DVT还应引起B超医师及临床医师的足够重视。     

预见性护理在预防全髋关节置换术下肢深静脉血栓形成的临床研究

目的：分析对于全髋关节置换术后患者进行预见性护理以预防下肢深静脉血栓形成(DVT)的临床效果。方法70例需行全髋关节置换术治疗的患者，随机分成观察组与对照组，每组35例。对照组入院后进行常规护理，观察组则进行预见性护理，对比两组的临床护理效果。结果观察组术后DVT发生率2.9%明显低于对照组20.0%，在发生时间、住院时间以及术后2、4周患者的下肢静脉血流速度均明显优于对照组(P<0.05)。结论对于需进行全髋关节置换术治疗的患者入院后进行预见性护理能有效预防术后DVT的发生，利于患者恢复，值得临床推广应用。     

低分子肝素对于人工全髋关节置换术后下肢深静脉血栓形成的预防

目的探讨人工髋关节置换术(THR)后用低分子肝素预防下肢深静脉血栓(DVT)形成的疗效和安全性。方法将2002年1月至2006年6月行人工全髋关节置换术的94例患者随机分为未用药组和用药组,其中未用药组46例,未预防性使用任何药物;用药组48例,围手术期给予低分子肝素预防性治疗。术后第7天,两组患者均行双侧下肢彩色多谱勒超声检查,了解DVT形成情况及两组术后DVT的发生率。结果未用药组中有22例DVT阳性,DVT的发生率47.8%,用药组中有9例DVT阳性,DVT的发生率18.8%,两组比较,差异有统计学意义(P<0.05)。未用药组近端DVT的发生率为19.6%,用药组近端DVT的发生率为2.1%,两组比较,差异有统计学意义(P<0.05)。用药组未发现术中术后出血增多以及药物不良反应。结论低分子肝素能显著降低人工全髋关节置换术后下肢深静脉血栓的发生率,且具有良好的安全性。     

Extended Dalteparin Prophylaxis for Venous Thromboembolic Events

Background

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are manifestations of venous thromboembolic events (VTEs). Patients undergoing major surgical procedures such as total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS) are at an elevated risk for VTEs. The American College of Chest Physicians’ (ACCP) guidelines recommend that such patients receive thromboprophylaxis for at least 10 days. In patients undergoing THR or HFS, extended prophylaxis for up to 28–35 days is the recommended approach for those at high risk of thromboembolic events. The NAFT (North American Fragmin Trial) compared the prophylactic efficacy of dalteparin with that of warfarin during the in-hospital period, and with that of placebo during the period of hospital discharge until day 35 postsurgery, in patients who underwent total hip arthroplasty. During both the in-hospital and the post-discharge time periods, dalteparin significantly reduced the occurrence of DVT. Given the clinical relevance of these results, the low specificity of the ACCP recommendations regarding optimal prophylaxis duration, and the importance of optimizing the efficiency of DVT prophylaxis in the practice setting, a cost-utility analysis was conducted comparing dalteparin 10-day and 35-day (extended) with a warfarin 10-day protocol, in patients undergoing major orthopedic surgeries such as THR, TKR, or HFS.

Design and setting

A three-arm decision model was developed using the prevalence of symptomatic DVT from NAFT publications, epidemiologic studies, and published meta-analyses. Healthcare resource use was abstracted from a survey of clinicians and from the economic literature. Utility estimates were obtained by interviewing a sample of 24 people from the general public using the time trade-off technique. The clinical, economic and utility data were then used to estimate the cost per quality-adjusted life-year (QALY) gained with dalteparin for 10 or 35 days relative to 10 days of warfarin.

Study perspective

Canadian provincial healthcare system.

Main outcome measures and results

The cost per QALY gained with 10 days of dalteparin was below $Can1000 for all the surgeries evaluated (all costs are reported in 2007 Canadian dollars [$Can1 = $US1, as of December 2007]). In the case of extended prophylaxis, the incremental cost per QALY gained with 35 days of dalteparin over warfarin was $Can40 100, $Can46 500, and $Can31 200 for patients undergoing THR, TKR, and HFS, respectively. Reducing the duration of prophylaxis from 35 to 28 days generated ratios that were below $Can35 000 for all three surgeries evaluated.

Conclusions

Ten days of dalteparin following major orthopedic surgery is a clinically and economically attractive alternative to warfarin for DVT prophylaxis. In the case of the 35-day dalteparin protocol, the results also indicated acceptable economic value to a publicly funded healthcare system, particularly in the settings of HFS and THR. In addition, reducing the duration of prophylaxis to 28 days postsurgery would be associated with a more favorable return on public healthcare expenditures.     

Management patterns of thrombosis prophylaxis and related costs in hip and knee replacement in Germany

The objective of the study was to depict treatment strategies, health care utilisation and cost evaluation of hip and knee replacement surgery in Germany, with a particular emphasis on thrombosis prophylaxis (TP) for the prevention of deep vein thrombosis (DVT). In this multi-centre prospective cohort study, medical record data (socio-demographics, risk factors for thrombosis, thrombosis prophylaxis, course of hospital stay) were collected for patients undergoing either total hip replacement (THR) or total knee replacement (TKR). One and three months post-operatively, post-operative outcomes and health care resource use were documented by patient and physician questionnaires. A total of 309 patients participated in the study (59% female, mean age 66 [SD 10] years). Parenteral anticoagulation was administered for a mean of 38 (SD 16) days. 27 (9%) patients received subsequent oral anticoagulation for a mean of 38 (SD 21) additional days. Symptomatic DVT was reported by four (1.3%) patients. Mean overall direct costs associated with surgery from baseline to 3 months were EUR 11 264 (median 11 564, SD 2 481). Hospital and rehabilitation accounted for 97% of direct costs; costs for medications, physical therapy, physician office visits, out-of-pocket expenses, as well as complication costs accounted for an additional 3% of direct costs. Within these direct costs, a mean of EUR 348 (SD 361) was related to thrombosis prophylaxis, accounting for 3% of direct costs. Mean overall cost was EUR 11 926 (SD 2 481), including 6% indirect costs of productivity loss. Extended thrombosis prophylaxis was observed in the usual care setting of the study and associated with low incidence of symptomatic DVT. Thrombosis prophylaxis is — within the considerable economic burden of joint replacement surgery — a relatively small cost component.     

急性脑卒中患者下肢深静脉血栓形成66例临床分析

目的：探讨急性脑卒中患者下肢深静脉血栓形成（ DVT）的危险因素和临床特征、辅助检查特点、治疗及预后等,以期为住院脑卒中患者DVT的早期预防、早期诊断和早期治疗提供详细的临床资料。方法回顾性分析160例脑卒中患者的临床资料,对其中66例脑卒中后偏瘫并经超声检查证实的DVT患者资料与同期收治的94例非DVT卒中患者进行对比分析,探讨DVT的发生率、发生时间及可能的危险因素,总结其临床特点。结果脑卒中患者发生下肢DVT的时间平均为16 d。 DVT发生于高龄患者（≥65岁）44例,占66．67％;严重瘫痪者42例,占72．72％;长期卧床者52例,占78．78％;伴发疾病中以糖尿病、高血压、高脂血症为常见;DVT患者的平均血浆纤维蛋白原浓度为（5．02±1．38） g／L,明显高于非DVT组的（2．74±1．65）g／L,差异有统计学意义（t＝4．78,P＜0．01）。结论肢体瘫痪、长期卧床、高龄、血浆纤维蛋白原浓度增高等是发生下肢DVT的高危因素,临床上对此类患者应给予提前预防。     

Incidence and prevention of thromboembolic events in one stage bilateral total hip arthroplasty: a systematic review

We conducted a thorough search of all the English language literature and carried out a meta-analysis in an attempt to reveal potential differences on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) between one stage bilateral and unilateral total hip replacements, and to provide, if possible, recommendations on thromboembolic prophylaxis. We identified 37 citations eligible for inclusion. A total of 5868 bilateral simultaneous THR patients were identified. Analysis of data was performed with the Mantel-Haenszel method. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of deep vein thrombosis (p = 0.40) and pulmonary embolism (p = 0.39) when comparing staged with bilateral simultaneous THR procedures as well as the rates of pulmonary embolism when comparing bilateral simultaneous THR with unilateral procedures (p = 0.69). However, deep vein thrombosis rate was in favor of bilateral two-stage compared to unilateral THR (p = 0.00001). Definite recommendations regarding the prevention of thromboembolic events in bilateral simultaneous THR could not be produced as the literature was limited and the data heterogenic. Conclusively, deep vein thrombosis and pulmonary embolism is not increased in bilateral simultaneous THR, provided that appropriate prophylactic measures are taken. More data are needed in order to clarify if additional measures or altered protocols of thromboembolic prophylaxis should be followed.     

脑卒中并发下肢深静脉血栓形成的危险因素及护理干预

目的分析我院脑卒中患者并发下肢深静脉血栓形成（DVT）的危险因素,以期提出有效的护理防治措施。方法分析我院收治的432例脑卒中患者中,下肢深静脉血栓形成（DVT）的发生情况,并分析可能影响脑卒中患者发生DVT的危险因素。结果脑卒中患者发生DVT32例,发生率为7．4％。年龄≥60岁发生DVT高于≤60岁,差异有统计学意义（P〈0．05）;合并症以冠心病发生DVT的比例最高,其次为高血压、糖尿病。结论对脑卒中患者进行早期护理干预,以减少下肢深静脉血栓形成的发生。     

MIP-1α、DFR对老年卧床静脉血栓栓塞症的预测价值

目的 探讨巨噬细胞炎性蛋白因子1-α（MIP-1α）、D-二聚体/纤维蛋白原（DFR）等指标在静脉血栓栓塞 症（VTE）患者中的表达及其预测价值。方法 选择65周岁以上疑似VTE患者129例，根据下肢加压超声（CUS）和 CT肺血管造影（CTPA）将其分为非深静脉血栓形成组（DVT组）74例、深静脉血栓形成组（DVT组）34例、肺血栓栓塞 症组（PTE组）21例。在抗凝治疗前采集患者新鲜血液标本，收集血常规及凝血指标，计算中性粒细胞计数/淋巴细胞 计数比值（NLR）；采用免疫比浊法测定血浆D-二聚体水平，凝固法测定血浆纤维蛋白原水平，计算D-二聚体/纤维蛋 白原（DFR）；采用ELISA法测定血清MIP-1α的水平，实时荧光定量法检测MIP-1α mRNA的表达量。通过绘制ROC 曲线分析各指标对VTE的预测价值。结果 PTE组、DVT组D-二聚体、校正后D-二聚体、DFR水平均显著高于非 DVT组（P＜0.05）；3组纤维蛋白原差异无统计学意义。DVT组、PTE组血清MIP-1α水平高于非DVT组，PTE组低于 DVT组（P＜0.05）。DVT组、PTE组MIP-1α mRNA的相对表达量均高于非DVT组（P＜0.05）。D-二聚体、校正后D- 二聚体、DFR、MIP-1α 对老年 VTE 均有一定诊断价值，其中校正后 D-二聚体（AUC=0.864）的诊断效能最高，DFR （AUC=0.853）的诊断效能与传统D-二聚体（AUC=0.851）相当；MIP-1α（AUC=0.739）对VTE的诊断价值一般。NLR 对 VTE 的诊断无预测价值（P＞0.05）。结论 校正后 D-二聚体是诊断老年 VTE 较为理想的辅助诊断指标，DFR、 MIP-1α均可作为诊断VTE的方法，MIP-1α可能是评估静脉血栓形成及不稳定脱落的新指标。     

96例股骨颈骨折老年患者行人工髋关节置换术的围手术期护理体会

目的 探讨股骨颈骨折老年患者髋关节置换术围手术期的护理要点.方法 对我院2006年1月至2011年12月收治的96例股骨颈骨折老年患者人工髋关节置换术围手术期采用整体化护理模式,并进行系统回顾总结.结果 96例患者中2例出现消化道出血,2例出现静脉栓塞;所有患者均在术后2～3周出院.结论 正确的围手术期护理和康复锻炼能有效减少并发症,提高患者的生活质量,远期效果良好.     

下腔静脉滤器置入与下肢深静脉血栓形成复发的关系

肺栓塞(pulmonary thrombosis, PE)是下肢深静脉血栓形成(deep venous thrombosis, DVT)的严重并发症之一。为预防PE,下腔静脉滤器(inferior vena cava filter, IVCF)置入术得到了广泛的使用,但滤器的置入亦可能成为下肢DVT治疗后复发的原因。现回顾我院261例下肢DVT患者的治疗情况,探讨IVCF置入术与下肢DVT治疗后复发的关系。     

Risk factor for a residual deep vein thrombosis after fondaparinux administration in patient with postoperative replacement arthroplasty

Deep venous thrombosis (DVT) is a life-threatening postoperative complication and occurs frequently after total-knee-replacement arthroplasty (TKA) and total-hip-replacement arthroplasty (THA). Fondaparinux (FPX) has been used to treat and prevent DVT, however interindividual difference of the drug efficacy exists. Therefore, this chart review was retrospectively conducted to research risk factors for a residual DVT after FPX treatment. Total of 112 patients undergone TKA or THA were treated with 2.5 mg FPX once a day between postoperative day (POD) 1 and 14 from July 2007 through December 2008. Among these patients, 30 patients who were detected DVT on POD 4 were enrolled in this study. Thirty patients were divided into two groups according to the presence (n=11) or absence (n=19) of DVT on POD14. The DVT (-) group had a significantly longer activated partial thromboplastin time (APTT, median 31.4 s) on POD 1 than the DVT (+) group (28.5 s) (p<0.02). Multivariate logistic regression analysis revealed that APTT lower than 28.5 seconds on POD1 was considered to be independent risk factor significantly contributing to residual DVT (odds ratio 17.5, 95% confidential interval 2.0-295.4, p=0.02). These findings should provide useful information for understanding the interindividual difference of the efficacy of FPX after TKA or THA.