人工全膝关节置换影响红细胞脂质过氧化的研究

[目的]探讨人工全膝关节置换术对围手术期红细胞脂质过氧化的影响及维生素E(VitE)、1,6-二磷酸果糖(FDP)对红细胞脂质过氧化的防治作用。[方法]膝关节退变伴骨性关节炎患者60例,于硬膜外阻滞麻醉下行人工全膝关节置换术,随机分为四组:即对照组、术前应用维生素E组、术中应用FDP组及术前应用维生素E联合术中应用FDP组。每组15例,在手术前、术后1、3、5、7d抽取血样,测定红细胞中丙二醛(MDA)和铜-锌-超氧化物歧化酶(Cu-Zn-SOD)的含量。[结果]人工全膝关节置换术后红细胞中MDA的含量明显比术前增高(P<0.05),而Cu-Zn-SOD的含量明显比术前降低(P<0.05);术前应用VitE联合术中应用FDP比单纯应用VitE或FDP能在围手术期更有效地保护红细胞免受脂质过氧化的损伤(P<0.05)。[结论]人工全膝关节置换术,应提倡术前服维生素E和术中用FDP,以预防围手术期氧自由基和过氧化脂质等有害因子对红细胞的破坏,以及因红细胞损伤可能出现的深静脉血栓形成等并发症的发生。     

脊柱手术对红细胞脂质过氧化影响的临床研究

目的探讨脊柱手术对红细胞脂质过氧化的影响及维生素E、1,6-二磷酸果糖（fructose 1,6-diphosphate,FDP）对脂质过氧化的防治作用。方法脊柱手术患者40例,在全麻下行手术治疗,随机分为四组：对照组、术前应用维生素E组、术中应用FDP组及术前应用维生素E联合术中应用FDP组。每组10例,于手术前1 d、术后1、3、5、7、14 d抽取血样,测定红细胞丙二醛含量。结果脊柱手术后红细胞中丙二醛含量明显比术前增高（P〈0.05）;术前应用维生素E联合术中应用FDP比单纯应用维生素E或FDP能在围手术期更有效地保护红细胞免受脂质过氧化的损伤（P〈0.05）。结论脊柱手术术前服用维生素E和术中应用FDP,可以预防围手术期氧自由基和过氧化脂质等有害因子对红细胞的破坏,以及因红细胞损伤可能出现的深静脉血栓形成等并发症。     

低分子肝素预防人工髋关节置换术后下肢深静脉血栓形成

目的 对比观察采用低分子肝素(LMWH)预防人工髋关节置换(THR)术后下肢深静脉血栓形成(DVT)的临床效果.方法 将行人工髋关节置换术的132例患者随机分为未用药组和用药组,其中未用药组36例,未预防性使用任何药物;用药组96例,围手术期给予LMWH预防性治疗.术前及术后第7～14天,两组患者均行患肢彩色多谱勒超声检查,评价DVT形成情况及两组术后DVT发生率.结果 未用药组中有8例DVT阳性,DVT的发生率22.2%,用药组中有9例DVT阳性,发生率9.3%;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 LMWH可显著降低围手术期THR术后DVT的发生,且具有良好的安全性.     

整体护理在髋关节置换手术患者中预防下肢深静脉血栓形成的效果分析

目的总结整体护理在预防髋关节置换手术患者下肢深静脉血栓形成(DVT)的效果。方法对62例实施髋关节置换术患者围术期间实施术前评估、预防DVT相关知识宣教,术中密切配合、术后康复指导等整体护理措施。观察患者下肢深静脉血栓等并发症发生情况。结果 62例患者均顺利完成手术。术后仅发生1例(1.61%)下肢DVT,其余患者经多普勒超声检查证实未见DVT。未出现肺栓塞等其他并发症。结论在髋关节置换手术患者围术期实施整体护理,可降低DVT发生率,促进术后康复进程。     

全髋关节置换术后深静脉血栓形成

目的：探讨全髋关节置换术后下肢深静脉血栓形成（DVT）的发生情况及预防治疗措施。方法：对220例（244髋）全髋关节置换患者围手术期皮下注射低分子肝素来预防治疗下肢深静脉血栓形成。术后第7天行彩色多普勒超声检查。结果：58例发生下肢深静脉血栓，其中远端血栓33例，近端血栓14例，全静脉血栓11例，DVT发生率26．4％，未发生1例肺栓塞。结论：围手术期低分子肝素应用可降低全髋关节置换术后DVT发生率，且安全可靠。     

老年髋关节周围骨折围手术期应用低分子肝素预防下肢深静脉血栓的研究

目的探讨应用低分子肝素围手术期预防髋关节周围骨折下肢深静脉血栓(DVT)发生的有效性和安全性。方法选取髋关节周围骨折患者70例,随机分为两组,对照组行物理方法预防;实验组行物理方法加低分子肝素预防。比较两组DVT和并发症发生率。结果对照组术前7例DVT形成,发生率为18.42%,试验组发生率为0%,差异有统计学意义(P0.05);对照组31例中术后8例DVT形成,实验组32例中术后2例发生DVT;差异有统计学意义(P0.05)。无一例发生出血。结论应用低分子肝素能有效预防髋部骨折患者围手术期DVT的发生。     

胫骨骨折部位与下肢深静脉血栓形成发生风险及影响因素分析

目的观察胫骨骨折患者骨折部位与围手术期下肢深静脉血栓形成发生的风险,分析此类患者下肢深静脉血栓形成的危险因素。方法回顾性分析自2014-10—2019-05手术治疗的449例胫骨骨折,根据围手术期是否发生下肢深静脉血栓形成分组,分为血栓组与无血栓组。比较两组在性别、年龄、骨折部位、合并内科疾病、骨折至手术时间、术前与术后D-二聚体、术前与术后血红蛋白、术前与术后红细胞压积、手术时间、术中失血量、术中补液量、术中输血量方面的差异。结果 193例下肢深静脉血栓形成,其中远端血栓180例,远端血栓13例。胫骨近端骨折患者下肢深静脉血栓形成发生率高于胫骨中段骨折患者与胫骨远端骨折患者,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,年龄、骨折至手术时间、胫骨近端骨折、术前D-二聚体、术前血红蛋白、术前红细胞压积、术后D-二聚体、术后血红蛋白、术后红细胞压积是胫骨骨折患者围手术期下肢深静脉血栓形成的独立危险因素。结论胫骨近端骨折患者下肢深静脉血栓形成的发生率高于胫骨中段骨折与胫骨远端骨折患者。临床医师应警惕年龄大、近端骨折、骨折至手术时间长、贫血、D-二聚体水平升高的胫骨骨折患者出现下肢深静脉血栓形成。     

髋关节置换术中系统护理预防下肢深静脉血栓形成的效果

目的探讨髋关节置换术中系统护理预防下肢深静脉血栓形成(DVT)的效果。方法选取2015-06—2018-01间在淮滨县人民医院接受髋关节置换术的64例患者。将2015-06—2016-12间入院的34例患者作为对照组,行围术期常规护理。将2017-01—2018-01间入院的30例患者作为观察组,在围术期常规护理基础上联合术中系统护理。比较2组患者术后下肢DVT的发生率。结果观察组术后下肢DVT发生率低于对照组,差异有统计学意义(P0.05)。结论对接受髋关节置换手术的患者在围术期常规护理的基础上,联合术中系统护理,可有效降低术后DVT的发生率。     

脊柱外科围手术期患者下肢深静脉血栓诊断流程的构建及应用

目的 :将下肢深静脉血栓诊断的循证医学证据应用于脊柱外科围手术期患者下肢深静脉血栓诊断流程,以提高下肢深静脉血栓的早期检出率。方法:通过检索诊断下肢深静脉血栓的循证医学证据,结合临床情景和专业判断,最终纳入5条下肢深静脉血栓诊断的循证医学证据,并制定基于此5条循证医学证据的下肢深静脉血栓筛查诊断流程。选取2018年1～5月在中南大学湘雅二医院脊柱外科病房住院的443例围术期患者采取传统血栓诊断流程(传统方法组),即患者出现DVT临床表现或D-二聚体检测值明显高于其阳性临界值时再采取双下肢B超对患者DVT进行筛查诊断。于2018年7月1日～11月30日对同一病区住院的498例围术期患者行基于循证医学的DVT筛查诊断流程(新方法组)。比较两种方法应用前后,脊柱外科围术期患者DVT的发生率及患者确诊DVT时出现下肢肿胀、疼痛、皮肤颜色变紫变暗等DVT临床表现(症状性DVT)的发生情况;通过查看患者双下肢B超检查报告单统计患者DVT临床分型中周围型占比情况。结果:传统方法组与新方法组患者下肢深静脉血栓的发生率分别为2.93%、19.28%,两组比较差异有统计学意义(P<0.05);症状性...     

全膝关节置换术后下肢深静脉血栓形成的防治

目的对比观察采用低分子肝素预防全膝关节置换(TKR)术后下肢深静脉血栓形成(DVT)的临床效果。方法将2000年1月~2004年4月行人工膝关节置换术随机分两组,围手术期给予低分子肝素钠预防治疗25例,未预防性使用低分子肝素钠抗凝20例。结果预防组DVT总发生率为20%,对照组DVT发生率为60%,两组比较差异有统计学意义(P<0·05)。血浆D-二聚体含量在用药组阳性检出率20%,未用药组为50%。结论低分子肝素可显著降低人工膝关节置换术后下肢深静脉血栓的发生率,而且具有良好的安全性。血浆中D-二聚体含量的变化可用于下肢深静脉血栓形成的诊断。     

低分子肝素预防人工髋、膝关节置换术后下肢深静脉血栓形成的研究

目的 对比观察采用低分子有直素预防人工髋、膝置换术（ＴＨＲ、ＴＫＲ）后下肢深静脉血栓形成（ＤＶＴ）的临床效果。方法 将１９９７掉１１月－１９９９年３月行人工髋膝置换术的患者随机分为未用药组和用药组,其中未用药组共４７例患者,６２例关节置换,未预防性使用低分子肝素抗凝;用药组共３１例患者,３６例关节置换（１９膝,１７髋）,围手术期给予低分子肝素预防治疗。两组患者均于术后行下肢静脉造影检查。结果 用药     

血凝酶对人工髋关节置换术患者术后下肢静脉血栓形成的影响

目的 观察应用血凝酶对患者凝血功能及其下肢静脉血柃形成的影响.方法 40例行人工髋关节置换术患者随机均分为了两组:血L凝酶组术前5 min肌肉、静脉符注射血凝酶1 kU;对照组以生理盐水代替血凝酶作为对照.于用药前及用药后60、120 min抽取外周静脉血,测定D-二聚体(D-D)、抗凝血酶(AT)活性、凝血酶原时间(PT)和活化部分的凝血酶原时间(APTT)、组织型纤溶酶原激活剂(tPA-Ag)和组织型纤溶酶原激活抑制剂(PAI-1),用药前后进行舣下肢静脉血管超声榆查.结果 术后3～10 d血凝酶组发现远端静脉粗栓5例(25.0%);对照组6例(30.0%).血凝酶组给药后60 min时tPA-Ag明显高于埘照组(P＜0.05);州组其他相关凝血指标差异均无统计学意义.结论 术中应用血凝酶对患者凝血功能无明显影响,不增加术后下肢静脉血栓形成的发生率,但可能会促进纤溶活性.     

Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital: a 10-year prospective register of 3,954 patients

We studied the incidence of nonfatal, radiologically-confirmed, clinical pulmonary embolism (PE) after major joint surgery during 10 years of observation. The findings are based on a prospective register of all patients undergoing total hip replacement (THR), total knee replacement (TKR), or nailed hip fracture (NHF) in a Scandinavian hospital between 1989 and 1998. All patients received thromboprophylaxis with low-molecular-weight heparin, continued until discharge. Patients with suspected PE underwent ventilation/perfusion scintigraphy and/or spiral CT. Patients with concomitant clinical signs of deep vein thrombosis (DVT) were also subjected to imaging diagnostics. 3,954 patients underwent THR, TKR, or NHF; 122 of them were readmitted on clinical suspicion of PE, and 50 cases were confirmed. Of patients with confirmed PE, 6/50 had DVT. The average time to readmission was 35 (5-94) days after THR, 24 (1-173) days after NHF, and 9 (2-17) days after TKR. Following major hip surgery, the incidence of PE remained high for at least 2-3 months (less following TKR) in those given thromboprophylaxis for about 10 days. The differences in PE incidence and the time when it developed in NHF versus THR and TKR patients suggest that these patients should be considered separately when determining the optimal thromboprophylactic regimen.     

Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital

We studied the incidence of nonfatal, radiologically-confirmed, clinical pulmonary embolism (PE) after major joint surgery during 10 years of observation. The findings are based on a prospective register of all patients undergoing total hip replacement (THR), total knee replacement (TKR), or nailed hip fracture (NHF) in a Scandinavian hospital between 1989 and 1998. All patients received thromboprophy-laxis with low-molecular-weight heparin, continued until discharge. Patients with suspected PE underwent ventilation/perfusion scintigraphy andlor spiral CT. Patients with concomitant clinical signs of deep vein thrombosis (DVT) were also subjected to imaging diagnostics. 3,954 patients underwent THR, TKR, or NHF; 122 of them were readmitted on clinical suspicion of PE, and 50 cases were confirmed. Of patients with confirmed PE, 6/50 had DVT. The average time to readmis-sion was 35 (5-94) days after THR, 24 (1-173) days after NHF, and 9 (2-17) days after TKR. Following major hip surgery, the incidence of PE remained high for at least 2-3 months (less following TKR) in those given throm-boprophylaxis for about 10 days. The differences in PE incidence and the time when it developed in NHF versus THR and TKR patients suggest that these patients should be considered separately when determining the optimal thromboprophylactic regimen.     

Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty

Introduction There is a great deal of controversy about the effect of tourniquets on development of deep vein thrombosis (DVT) after total knee arthroplasty (TKA). Patients and methods We investigated the incidence of postoperative DVT after TKA with or without the use of a tourniquet. The patients were 48 consecutive patients undergoing primary ipsilateral cemented TKA for osteoarthritis. Group A (21 patients) underwent the operation without a tourniquet, and Group B (27 patients) underwent the operation with a tourniquet. Ultrasonography to assess DVT was performed before and after the operation. Results Group B had less intraoperative and total blood loss than Group A. Postoperative DVT was detected in 81.3% of all cases, and symptomatic pulmonary embolism occurred in 1.7%. Most of DVT was found in the calf vein. There was no significant difference in the incidence of postoperative DVT between the two groups. Conclusion We conclude that the use of a tourniquet is beneficial, because it decreases perioperative blood loss and does not increase the risk of DVT. The incidence of DVT after TKA is considerably high with or without use of a tourniquet. Therefore, prevention and early detection of DVT are important for prevention of fatal pulmonary thromboembolism.     

A review of the evidence for and against thromboprophylaxis in total hip replacement

Deep vein thrombosis (DVT) after an unprotected total hip replacement (THR) is common and this review explores the balance between risks and benefits of thrombo-prophylaxis in protecting patients undergoing THR. A literature search for English publications was conducted on Medline & PubMed. Governance bodies and their guidelines were consulted. MESH terms included Deep Vein Thrombosis OR DVT AND Prophylaxis AND Hip AND/OR Surgery AND/OR Total Replacement OR Arthroplasty. THR results in significant risk of thrombo-embolic complications with studies showing that as many as one half of patients suffer from DVT post-operatively. Prophylactic treatments are used to reduce the incidence of DVT. However, there are also risks associated with the use of prophylaxis, including excessive bleeding and major cardio-vascular events. Further investigation is required to determine which patients should be given what prophylaxis and for how long post THR.     

单侧与双侧使用间歇充气加压在预防髋膝置换术后DVT中的效果比较

目的探讨间歇充气加压（IPC）非手术侧使用,在髋膝关节置换术后下肢深静脉血栓（DVT）预防中的效果和安全性。 方法前瞻性收集2017年4月至2017年9月烟台市烟台山医院拟行髋、膝关节置换术且符合纳入及排除标准的患者172例,采用随机数字表法将患者随机分为试验组和对照组,所有患者均于麻醉后手术开始前开始行非术侧IPC治疗,术后给予利伐沙班抗凝预防DVT,试验组术后继续行持续性非术侧IPC预防DVT,共85例;对照组术后行持续性双侧IPC预防DVT,共87例。术后3 d后改为1 h,2次/日。术后3 d、7~10 d行双下肢超声检查监测DVT发生情况。 结果患者术后常规继续住院7~10 d,故术后患者无脱落,随访率100%。随访时间为7~10 d,平均（8.3±1.3）d,试验组术后3 d发生血栓11例,占12.9%,均为肌间静脉血栓;对照组术后3 d发生血栓8例,占9.2%,1例腘静脉血栓,2例胫腓静脉血栓,余为肌间静脉血栓;术后3 d两组膝关节置换患者、髋关节置换患者及总的DVT发生率均无统计学差异。术后7~10 d试验组新增血栓5例,占6.8%,对照组新增血栓4例,占比5.1%,两组术后7~10 d膝置换患者、髋置换患者及总DVT发生率均无统计学差异。 结论IPC非手术侧使用在预防髋膝置换术后下肢DVT发生中可达到与IPC双侧同时使用相同的预防效果,安全性更高。