康复训练对关节置换术后下肢深静脉血栓的预防作用

目的 探讨康复训练预防髋、膝关节置换术后下肢深静脉血栓（DVT）的疗效和安全性。方法 选择56例接受髋、膝关节置换术的患者，随机分成预防组和对照组，预防组术后进行足踝主动运动、股四头肌等长收缩运动和深呼吸训练，对照组术后嘱患者家属按摩患者患侧小腿。术前和术后第7天分别行彩色多普勒超声检查，检测股静脉血流速度及观察下肢DVT的发生情况。结果 康复训练后，预防组股静脉血流峰速度和平均速度均高于对照组，差异有统计学意义（P〈0.01）；预防组有1例患者（3．57％）发生DVT，对照组有6例患者（21．43％）发生DVT，2组比较差异有统计学意义（P〈0.05）。结论 足踝主动运动、股四头肌等长收缩运动结合深呼吸训练可提高下肢静脉血流速度，安全、有效地预防髋、膝关节置换术后下肢DVT的形成。     

全髋及膝关节置换术后并发症的预防及功能康复

目的：探讨预防全髋及膝关节置换术后下肢深静脉血栓(DVT)的发生及功能康复的有效措施。方法：82例膝关节置换术患者，分为康复组和对照组。康复组42例术前进行康复指导，术后早期即开始系统的功能锻炼，并应用低分子肝素预防DVT。对照组40例按常规治疗。比较分析2组Harris评分和下肢深静脉血栓发生情况。结果：康复组42例患者无DVT发生，住院时间缩短，关节功能恢复良好，未发生明显的出血性并发症；Har—ris评分和下肢深静脉血栓发生率与对照组比较差异有显著性。结论：围手术期有效的预防、术后早期系统的康复锻炼是避免下肢深静脉血栓形成的有效措施并有助于患者关节功能的恢复。     

老年人腹部手术后下肢深静脉血栓形成的预防

目的：总结老年人腹部手术后下肢深静脉血栓形成的预防方法。方法：回顾性分析527例老年人腹部手术的临床资料，治疗组285例术后给予一定的预防下肢深静脉血栓形成措施，对照组242例未给予任何预防措施。结果：治疗组术后并发下肢深静脉血栓形成3例，占1．1％，对照组术后并发下肢深静脉血栓形成17例，占7．0％，两组比较差异有统计学意义（P〈0．05）。结论：采取积极有效的预防方法可明显降低老年人腹部手术后下肢深静脉血栓形成的发生。     

护理干预对髋部术后应用速碧凝预防深静脉血栓的疗效观察

目的：探讨髋部手术后下肢深静脉血栓（DVT）的预防与护理措施。方法：将54例髋部术后患者随机分成速碧凝组（LMWH组）和对照组，其中LMWH组26例，术后使用速避碧预防治疗，并进行主动和被动功能锻炼；对照组28例，术后不采取抗凝措施；两组手术后7、14d行彩色多普勒检查，了解深静脉血栓形成情况。结果：LMWH组中有4例（15．4％）发生DVT，对照组中有12例（42．8％）发生DVT，两组比较有显著性差异（P〈0．05）。结论：髋部手术后早期预防性的应用速碧凝，并加强早期功能锻炼，对减少DVT并发症的发生有重要意义。     

关节置换术后康复训练预防下肢深静脉血栓疗效分析

目的评价康复训练在预防关节置换术后下肢深静脉血栓(DVT)的作用。方法将50例髋、膝关节置换术的患者随机分成两组,实验组术后进行足踝主动运动、股四头肌等长收缩运动和深呼吸训练,对照组术后被动按摩偏瘫侧比目鱼肌和腓肠肌。比较术前和术后1周股静脉血流速度及下肢DVT的发生情况。结果经康复训练,实验组股静脉血流峰速度高于对照组(P<0.01);实验组有1例发生DVT,对照组有4例发生DVT,两组比较差异有统计学意义(P<0.05)。结论康复训练可有效预防髋、膝关节置换术后下肢DVT。     

知信行健康教育模式在全髋膝关节置换术后深静脉血栓预防中的应用

目的探讨知信行健康教育模式对全髋膝关节置换术后患者下肢深静脉血栓预防的相关知识认知程度及对下肢深静脉血栓发生的影响。方法选择2015年1~12月98例择期行全髋膝关节置换的患者为研究对象,随机分成两组,其中对照组49例,行常规下肢深静脉血栓预防健康教育,另外49例患者为观察组,行知信行健康教育方式。结果观察组干预后DVT知识掌握情况优于对照组,差异有统计学意义(P0.05),观察组仅发生1例DVT(2.04%),而对照组出现6例(12.24%),发生率高于观察组,差异有统计学意义(P0.05)。结论知信行健康教育模式能有效提高髋膝关节置换术后患者DVT疾病相关知识掌握程度,降低DVT的发生率。     

循环驱动仪预防髋膝关节置换术后患者下肢深静脉血栓的观察

目的研究循环驱动仪预防髋膝关节置换术后下肢深静脉血栓形成的临床疗效。方法按入院先后顺序将88例接受髋膝关节置换术的患者随机分成两组,各44例。实验组采用常规预防措施加用循环驱动仪治疗为循环驱动仪组。对照组采用常规预防措施为传统干预组。术后4~7d行患侧静脉造影,了解深静脉血栓发生的情况。结果两组疗效经字2检验,P<0.01,有显著性差异。说明循环驱动仪组疗效优于传统干预组。结论循环驱动仪能安全有效地预防髋膝关节置换术后深静脉血栓的形成。     

宫颈癌手术患者预防下肢深静脉血栓形成的护理干预

目的探讨宫颈癌术后患者下肢深静脉血栓（DVT）的预防及护理。方法对2011年1月-12月151例宫颈癌手术患者（纳入观察组）采用积极的下肢静脉血栓护理干预措施,并与2010年1月-12月同样行宫颈癌手术且实施常规护理的146例患者（纳入对照组）资料进行对比,观察验证血栓护理干预与常规护理方法对预防患者术后DVT的效果。结果观察组出现下肢肿痛、活动受限等血栓样症状者5例,发生率3．3％;对照组出现下肢血栓样症状者31例,发生率21．0％,两组血栓发生率比较差异有统计学意义（P〈0．05）。结论积极的护理干预措施可有效降低患者术后下肢DVT的发生。     

开胸术后下肢深静脉血栓形成原因及护理探讨

目的探讨开胸术后下肢深静脉血栓（DVT）的原因及护理对策。方法对16例开胸术后发生DVT的相关因素进行分析。结果开胸术后发生DVT16例，发生率为1．37％；左下肢占75％，明显高于右下肢；治疗有效率达95％。结论对DVT患者进行早期干预，降低DVT的发生率，避免肺栓塞等并发症的发生。     

不同长度梯度压力袜对预防关节置换术后下肢深静脉血栓形成的效果研究

目的探讨不同长度梯度压力袜对预防关节置换术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的效果。方法将160例关节置换术后患者随机分为A组和B组,每组80例,两组患者术后第1天均给予充气压力泵(气压式血液驱动带)、抗凝药物(拜瑞妥或克赛)等常规预防血栓治疗。A组患者于术后第1天穿短腿梯度压力袜,B组患者于术后第1天穿长腿梯度压力袜。两组患者均于术后3～5d常规行双下肢深静脉彩超,观察下肢深静脉血栓发生情况。结果A组4例患者发生下肢深静脉血栓,占5.0%;肌间血栓25例,占31.25%。B组患者2例发生下肢深静脉血栓,占2.5%;肌间血栓20例,占25.0%。两组患者下肢DVT发生率差异无显著意义(P>0.05)。结论不同长度梯度压力袜对预防关节置换术后下肢深静脉血栓形成的效果是相同的。     

协同护理在预防老年人工髋关节置换术后患者下肢深静脉血栓形成中的应用

目的:探讨协同护理在预防老年人工髋关节置换术(HA)术后患者下肢深静脉血栓形成(DVT)中的应用效果。方法:将84例老年HA患者随机分为干预组和对照组各42例,对照组接受常规血栓预防措施,干预组在对照组基础上进行协同护理干预。比较两组干预前后DVT预防相关知识得分、髋关节功能(Harris)评分及优良率、腓肠肌疼痛(Homan征)发生率和下肢彩色多普勒超声检查DVT发生率。结果:干预后干预组患者DVT预防相关知识得分高于对照组(P<0.01);干预组髋关节功能Harris评分(86.5±10.8)分,高于对照组(80.8±11.7)分,比较差异有统计学意义(t=2.330,P=0.022);干预组术后髋关节功能优良率为78.6%,对照组为57.1%,两组比较差异有统计学意义(χ2=4.421,P=0.035);干预组Homan征发生率为2.4%,对照组为11.9%,两组比较差异无统计学意义(P>0.05);下肢彩色多普勒超声检查结果显示,干预组DVT发生率为7.1%,对照组DVT发生率为23.8%,两组比较差异有统计学意义(χ2=4.459,P=0.035)。结论:协同护理能够提高老年HA术后患者DVT预防相关知识水平,改善髋关节功能,对预防患者下肢DVT的发生起到积极作用。     

Does venous microemboli detection add to the interpretation of D-dimer values following orthopedic surgery?

The identification of risk factors for deep venous thrombosis (DVT) following orthopedic surgery remains unclear. We have investigated the relationship between plasma levels of D-dimer (DD), the presence or absence of microemboli 1 day after surgery, and the occurrence of DVT 7 days after total hip or knee replacement. The prevalence of DVT was 25 (13.3%) among 188 patients and was lower in 112 patients with DD < 2808 ng mL(-1) than in the 56 patients with higher DD levels: respectively, 8.0% vs. 21.4% (p < 0.05). D-dimer is not suitable for individual estimation of DVT risk. Microemboli were found in 112 (60%) of 186 subjects. The presence/absence or the frequency of the microemboli showed no relationship with the occurrence of DVT. Last, when evaluating the risk of DVT in orthopedic surgery, microemboli detection does not add to the interpretation of DD concentration.     

利伐沙班预防髋关节置换术后血栓形成的效果观察

目的 观察利伐沙班预防髋关节置换术后血栓形成的效果.方法 将127例髋关节置换术患者分为预防组和对照组,对照组用常规基础及机械预防,预防组在此基础上,采用药物抗凝剂利伐沙班口服,观察比较两组术后深静脉血栓（DVT）形成例数.结果 预防组发生深静脉血栓0例,对照组16例.两组比较差异有统计学意义（P＜0.05）.结论 利伐沙班预防髋关节置换术后静脉血栓形成疗效显著,应用方便,安全.     

利伐沙班和低分子量肝素钙在人工关节置换术后预防深静脉血栓形成的效果比较

目的观察利伐沙班与低分子量肝素钙预防人工关节置换术后深静脉血栓(DVT)形成的疗效。方法 2009年11月~2010年10月行膝关节置换及全髋置换的患者167例,其中全髋置换患者114例,膝关节置换患者53例。以患者住院时间顺序分为两组:利伐沙班组(n=84):术后6 h内开始使用利伐沙班10 mg/d,1次/日,口服,膝关节置换术2周,全髋置换术5周。低分子量肝素钙组(n=83):手术前2 h及手术后每天皮下注射低分子量肝素钙2500 IU,5 d。疗效评定:术前与术后行双下肢静脉超声,了解深静脉管腔大小改变、DVT发生率;凝血功能于实验开始前和治疗2 d、5 d、1周、2周、5周末各测定1次。结果①DVT发生率比较:利伐沙班组中有9例发生DVT(10.7%);低分子量肝素钙组中有15例患者发生DVT(18.1%)。②下肢静脉管腔大小前后变化比较:股浅静脉狭窄>2 mm者,利伐沙班组中有23例(27.4%),低分子量肝素钙组中有38例(45.8%);腘静脉狭窄>2 mm者,利伐沙班组中有27例(32.1%),低分子量肝素钙组中有47例(56.6%),两者比较差异有统计学意义(P<0.01)。③凝血功能检测:活化部分凝血活酶时间延长10 s以上者,利伐沙班组0例(0%),低分子量肝素钙23例(27.7%)(P<0.01)。结论利伐沙班在人工关节置换术后预防深静脉血栓形成较低分子量肝素钙效果更佳,且凝血功能几乎不受影响。     

系统早期活动方案降低关节置换术后深静脉血栓形成风险的研究

目的制定系统早期活动方案,了解其预防深静脉血栓形成(deep venous thrombosis,DVT)的临床效果。方法将102例实施髋、膝关节置换的骨科住院患者随机分成实验组和对照组,实验组实施系统早期活动方案,对照组给予目前临床预防DVT的护理常规。分别在术前及术后12d内观察两组患者DVT的相关症状;测量术前及术后第7天血浆D-二聚体水平。结果实验组术后早期DVT相关症状少于对照组;在术后第7天实验组血浆D-二聚体水平明显低于对照组。结论系统早期活动方案能够减轻关节置换患者术后DVT的相关症状并可降低血液高凝状态,对降低DVT发生风险有效。     

Bilateral vs. ipsilateral venography as the primary efficacy outcome measure in thromboprophylaxis clinical trials: a systematic review.

Contrast venography, in combination with symptomatic venous thromboembolism (VTE), is the standard efficacy outcome measure in clinical trials of thromboprophylaxis in major orthopedic surgery. It is uncertain whether performing bilateral venography offers any real advantage over venography of the operated leg alone. This study was undertaken to determine the risk of isolated contralateral deep vein thrombosis (DVT) following major orthopedic surgery and to evaluate whether bilateral venography, rather than venography on the operated leg alone, offers any gain in DVT detection and, thereby, improves efficiency in clinical study design. A systematic review of prospective studies that reported DVT incidence as the primary efficacy outcome based on mandatory bilateral venography in patients undergoing elective hip or knee arthroplasty or hip fracture repair was conducted. Based on the use of bilateral venography as a primary efficacy outcome measure, the incidence of any DVT is 16.7% following total hip replacement, 18.8% after hip fracture repair, and 33.8% after total knee replacement. While DVT risk in the operated leg varies depending on the type of surgery, the risk of isolated DVT in the non-operated leg is approximately 4% to 5% in all three procedures. By increasing the detection of any DVT, the use of bilateral venography reduces required sample size by 16% to 25% compared to ipsilateral venography. In clinical trials evaluating the efficacy of thromboprophylaxis in major orthopedic surgery, bilateral venography reduces the risk of undiagnosed DVT in the non-operated leg and improves the efficiency of study design by substantially reducing the sample size requirement.     

老年全髋关节置换术后DVT的危险因素

目的 探讨老年行全髋关节置换术后发生深静脉血栓(DVT)的危险因素及预测因子。方法 分析2012年7月至2017年5月在我院首次接受全髋关节置换术治疗的217例髋关节疾病患者的临床资料。入组患者根据术后30d内是否发生DVT分为DVT组和非DVT组。比较两组患者的基线资料、合并症、手术相关指标,血常规、血凝、生化以及血液纤溶相关指标。结果 本研究共纳入217例患者,其中DVT组患者24例,非DVT组患者193例。DVT组患者的年龄、糖尿病、房颤、冠心病比例、手术时间均显著高于非DVT组患者(P<0.05)；DVT组患者的Alb、TAFI显著低于非DVT组,而D-二聚体及PAI-1水平则显著高于非DVT组(P<0.05)；Logistic多因素回归分析提示PAI-1为DVT发生的独立危险因素(OR：1.19,95%CI:1.05-1.31,P=0.012)。结论 老年全髋关节置换手术患者术前PAI-1水平的升高是术后DVT的独立危险因素。     

Fondaparinux for prevention of venous thromboembolism in major orthopedic surgery

OBJECTIVE: To review clinical information related to fondaparinux, a synthetic pentasaccharide recently approved for the prevention of deep-vein thrombosis (DVT) in patients undergoing major orthopedic surgeries and for extended DVT prophylaxis after hip fracture surgery. DATA SOURCES: Primary and review articles were identified by MEDLINE (1983-June 2003) using the key words pentasaccharide, Org31540, SR90107A, DVT prophylaxis, and fondaparinux. Additional sources were found listed in articles, abstracts, and unpublished data on file from the manufacturer. Articles selected were based on their coverage of the pharmacology, pharmacokinetics, safety, and efficacy of fondaparinux. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified were evaluated and all information deemed relevant was included. DATA SYNTHESIS: Fondaparinux is a selective antithrombin-dependent, indirect inhibitor of activated factor Xa. It has a favorable and predictable pharmacokinetic profile when administered subcutaneously, and has a long half-life, allowing once-daily dosing. Fondaparinux lacks in vitro cross-reactivity with heparin-induced antibodies. Major Phase III studies have demonstrated that subcutaneous fondaparinux sodium 2.5 mg given at least 6 hours postoperatively resulted in a 55% reduction in the risk of venous thromboembolism (VTE) in patients undergoing hip fracture surgery, total hip replacement surgery, or knee replacement surgery compared with standard enoxaparin therapy. It has a safety profile similar to that of enoxaparin with respect to clinically relevant major bleeding, including fatal bleeding, nonfatal bleeding, and bleeding requiring repeat surgery. The use of fondaparinux for prolonged prophylaxis after hip fracture has demonstrated further reduction in VTE events without increasing the risk of bleeding.CONCLUSIONS: Fondaparinux is the first of a new class of synthetic factor Xa inhibitors that demonstrated greater efficacy compared with enoxaparin for the prevention of VTE in major orthopedic surgery without an increase in clinically relevant bleeding. Given the favorable cost-effectiveness analysis and improved efficacy profile, fondaparinux should be considered for formulary addition for DVT prophylaxis in patients undergoing hip and knee replacement surgery. In patients undergoing hip fracture surgery, fondaparinux should be considered the DVT prophylaxis of choice. Extended thromboprophylaxis up to 28 days resulted in additional reduction in VTE (both symptomatic and venography-proven DVT) in patients with hip fracture surgery.