彩色多普勒超声对人工髋关节置换术后并发下肢深静脉血栓易发因素及治疗方法疗效的对比研究

目的:研究人工髋关节置换术后下肢深静脉血栓形成的易发因素及常见治疗方法间的疗效对比。材料与方法:通过对髋关节疾患行全髋置换术治疗的267例病例,进行前瞻性随机对照研究。根据患者并发下肢深静脉血栓的风险程度不同,按随机分组设计将其随机分为4个研究组。甲组(对照组):无预防措施。乙组(预防组):(1)组:使用低分子肝素(LMWH)预防;(2)组:使用下肢间歇性气囊加压(IPC)预防;(3)组:使用中药川穹、当归等活血药物预防。应用彩色多普勒超声分别于术前一天、术后第二天对患者双下肢静脉血管进行扫查,如有血栓形成,则继续动态观察,应用统计学方法,进行组间及组内对照分析。结果:预防组比对照组下肢深静脉血栓发生率显著下降(p=0.006),预防组组间下肢深静脉血栓发生率无显著差异(p=0.067)。四组中LDVT最常见部位为股浅静脉,占57.1%(16/28),其次为小腿肌间静脉,占42.8%(12/28)。甲组中发现下肢深静脉血栓数于术后4天最多,第3-5天发现比例为76.8%。高危因素是引起LDVT的重要因素,其中甲组高危患者中发生血栓的患者比例为19/33=57.6%,中危患者中发生血栓的患者比例为3/28=10.7%,低危患者中发生血栓的患者比例为1/23=4.3%。高危患者发生率较后三者有显著差异(p0.05)。结论:彩色多普勒超声对人工髋关节置换术后LDVT检查有重要价值。高年龄、术后患肢制动、血液高凝状态等高危因素是形成LDVT的重要原因。LDVT最常见的部位为股浅静脉及肌间静脉。人工髋关节置换术后第3-5天是LDVT的易发期。术后采取积极的预防措施具有重要临床意义。     

妇科盆腔手术后下肢深静脉血栓形成的预防护理

下肢深静脉血栓(LEDVT)是妇科术后,尤其是妇科盆腔手术后近期严重的并发症之一.文献报道,发达国家妇科盆腔手术后LEDVT的发病率为11%～29%[1], 我国妇科盆腔手术后LEDVT的发生率为0.2%～15.6%[2-3].由于下肢深静脉血栓形成可引起下肢功能障碍,其病情复杂多变,血栓易脱落,随血液循环运行可致肝、肾、肺栓塞,若不积极治疗将会致残,严重者发生肺栓塞而死亡,故对妇科盆腔手术后LEDVT的预防护理十分重要.本科室结合临床实际,采取积极有效的预防措施,减少了LEDVT的发生,现报告如下.     

妇科手术后下肢深静脉血栓超声特点及其引发肺栓塞危险性的初步研究

目的 分析妇科手术后下肢深静脉血栓(LDVT)特点及其引发肺栓塞(PE)的危险性,同时探讨彩色多普勒超声在妇科手术后对LDVT诊断价值.方法 研究对象为2008年4月至2008年12月所有于我院进行妇科手术的资料完整的患者395例.分别于手术前24 h、术后48～72 h及术后96～120 h,常规扫查患者双下肢深静脉,若有血栓,则进一步行螺旋CT肺动脉造影(CTPA),明确有无肺栓塞,并彩色多普勒超声继续动态观察.术后超声检查未见LDVT,而临床症状、体征或实验室检查不能除外肺栓塞的患者,亦要进行CTPA检查,明确有无肺栓塞.结果 妇科盆腔手术后早期无积极预防措施时LDVT形成的发生率为11.1%, LDVT患者42.8%发生肺栓塞.结论 妇科术后,下肢深静脉血栓最常见的部位是小腿深静脉;且引发肺栓塞危险性高,小腿深静脉血栓的栓子是引发肺栓塞的主要因素.妇科手术后早期对高危人群常规行双下肢静脉,尤其是小腿深静脉超声检查具有重要价值.     

基础预防联合IPC治疗预防骨科大手术后深静脉血栓形成的临床效果

目的:探讨基础预防联合间歇充气加压装置(IPC)治疗预防骨科大手术后下肢深静脉血栓(DVT)形成的临床效果。方法:将50例骨科大手术的患者随机分为实验组和对照组各25例,实验组采用基础预防联合IPC治疗;对照组给予血栓预防的常规护理。所有患者术后10 d行下肢彩色多普勒超声检查。结果:实验组DVT的发生率8%,明显低于对照组的32%,两组比较有显著性差异(P<0.05)。结论:基础预防联合IPC治疗能显著降低骨科大手术后DVT的发生率;并具有高度的安全性,对药物预防DVT有顾虑时是一个良好的选择。     

妇科盆腔手术后下肢深静脉血栓形成的预防护理

下肢深静脉血栓（KEDVT）是妇科术后,尤其是妇科盆腔手术后近期严重的并发症之一。文献报道,发达国家妇科盆腔手术后LEDVT的发病率为11％～29％,我国妇科盆腔手术后LED—VT的发生率为0．2％～15．6％。由于下肢深静脉血栓形成可引起下肢功能障碍,其病情复杂多变,血栓易脱落,随血液循环运行可致肝、肾、肺栓塞,若不积极治疗将会致残,严重者发生肺栓塞而死亡,故对妇科盆腔手术后LEDVT的预防护理十分重要。本科室结合临床实际,     

低分子肝素对人工关节置换术后下肢深静脉血栓形成的预防效果

目的观察经低分子肝素(LMWH)预防的人工关节置换术后患者的下肢深静脉血栓发生率.方法对121例经低分子肝素预防的人工关节置换术患者于术前、术后进行彩色多普勒超声检查,评价下肢深静脉通畅情况.结果经LMWH预防的人工关节置换术后DVT发生率为50.4%,全髋关节置换术后DVT发生率为13.3%,全膝关节置换术后为72.4%(P＜0.005),双膝关节置换术后DVT发生率高于单膝关节置换术后(P＜0.05).人工关节置换术后近端DVT发生率为3.3%,远端DVT发生率为47.1%.结论尽管采用LMWH预防,人工关节置换术后下肢DVT发生率仍然很高,术后有必要早期应用彩色多普勒超声进行监测,及时发现、治疗下肢深静脉血栓.     

观察低分子肝素钠预防妇科盆腔手术后下肢深静脉血栓形成的效果

目的:观察并分析在妇科盆腔手术后应用低分子肝素钠对于预防下肢深静脉血栓的临床价值。方法:选取2013年6月~2014年6月80例妇科盆腔手术患者,依据术后处理方法的不同分为观察组与对照组,每组40例。术后对照组行下肢按摩等常规处理,观察组在对照组基础上加用低分子肝素钠。对比分析两组下肢深静脉血栓的发生率和不良反应发生情况。结果:观察组与对照组下肢深静脉血栓的发生率分别为7.5%、30.0%,观察组显著低于对照组,差异有统计学意义(P0.05);两组均不存在明显的不良反应。结论:在妇科盆腔手术后应用低分子肝素钠能够显著地降低下肢深静脉血栓发生率,且安全性强,值得临床推广。     

观察低分子肝素钠预防妇科盆腔手术后下肢深静脉血栓形成的效果

【】目的：观察并分析在妇科盆腔手术后应用低分子肝素钠对于预防下肢深静脉血栓的临床价值。方法：2013年6月~2014年6月,选取80例妇科盆腔手术患者,依据术后处理方法的不同将其列入观察组与对照组,每组各为40例。术后对照组行下肢按摩等常规处理,在对照组基础上,观察组加用低分子肝素钠。对比分析两组下肢深静脉血栓的发生率和不良反应的发生情况。结果：观察组与对照组下肢深静脉血栓的发生率分别为7.5%、30.0%,观察组要显著低于对照组,差异有统计学意义(P＜0.05)；两组均不存在明显的不良反应。结论：在妇科盆腔手术后应用低分子肝素钠能够显著地降低下肢深静脉血栓的发生率,且安全性强,因此,可推广。     

间歇充气压缩泵与低分子肝素预防急性脊髓损伤下肢深静脉血栓的效果和安全性

目的 探讨间歇充气压缩泵(IPC)与低分子肝素(LMWH)预防急性脊髓损伤(ASCI)下肢深静脉血栓(DVT)的效果和安全性.方法 84例ASCI患者随机分为IPC组、LMWH组、IPC+LMWH组和对照组,分别给予持续IPC、注射LMWH、二者联合运用和常规护理按摩.观察各组股静脉和胭静脉血流速度;检测部分凝血酶时间(APTT)、活化凝血时间(ACT)和血小板功能(PF);记录患者发生下肢DVT的例数和时间;并对相关不良事件进行分析.结果 对照组中3例患者发生下肢DVT(14.28%),余组患者均未发生下肢DVT(P<0.05).IPC可以提高下肢静脉血流速度,对凝血系统和PF无影响.注射LMWH可以延长APTY、ACT并降低PF,单独使用未见并发症发生,二者联用可以观察到双重效果,但也发生1例出血倾向,可能与LMWH导致凝血功能改变有关.结论 相对常规护理按摩,其余3组方案预防下肢DVT效果更佳,IPC和LMWH在预防ASCI患者下肢DVT形成的效果相当,但IPC治疗更为安全.     

间歇充气压力泵与TED压力袜联合应用预防骨科下肢手术后深静脉血栓形成的安全性及有效性

目的 观察联合应用间歇充气压力泵(intermittent pneumatic compression,IPC)与TED梯度压力袜(graded compression stocking,GCS)预防骨科下肢术后深静脉血栓(deep vein thrombosis,DVT)形成的安全性及有效性.方法 选择2011年1月至2012年5月158例骨科下肢手术患者,将其分为3组,即对照组45例,GCS组48例和GCS+IPC组65例.对照组给予低分子肝素(LMWH)皮下注射预防DVT形成.术后采用彩色多普勒超声及临床症状观察对各组进行评估,比较3组患者DVT形成的情况、栓子的检出率及栓子的直径和使用GCS和IPC安全性.结果 术后10 d,对照组有3例DVT形成,且栓子直径＞0.5 cm;GCS组和GCS+IPC组均无DVT发生,GCS组静脉栓子检出率低于对照组,GCS+IPC组静脉栓子检出率更低,且均为可自行吸收栓子(直径0.1～0.2 cm);安全性明显优于对照组.结论 骨科下肢术后联合应用间歇充气压力泵与TED梯度压力袜能有效的预防深静脉血栓的形成且安全性高.     

压力带与抗栓泵联合使用预防妇科盆腔手术患者下肢深静脉血栓的研究

目的探讨压力带与抗栓泵对妇科盆腔手术后患者下肢深静脉血栓形成的预防作用。方法将150例妇科盆腔手术患者随机分为对照组、观察组和肝素组,每组各50例,对照组采取踝泵运动等常规下肢深静脉血栓形成干预措施;观察组在常规干预的基础上加用抗栓泵及压力带;肝素组在常规干预措施的基础上加用抗栓泵及低分子肝素。结果观察组术后凝血功能各项指标均在正常范围,肝素组术后凝血酶原时间及活化部分凝血酶时间显著延长并超出正常高值。观察组、肝素组预防下肢深静脉血栓形成效果优于对照组（P〈0．01）。结论压力带与抗栓泵联合使用可增加下肢静脉回心血流量,改善血液高凝状态,可减少妇科盆腔手术患者下肢深静脉血栓的发生,并且肝素组无潜在的出血风险,值得临床推广使用。     

低分子肝素预防妇科肿瘤术后下肢深静脉血栓形成的研究

【目的】探讨妇科肿瘤术后早期应用低分子肝素预防下肢深静脉血栓（DVT）的临床疗效。【方法】89例妇科肿瘤手术患者随机分威肝素治疗组47例与对照组42例,治疗组术后12h、24h、48h均皮下注射低分子肝素5000μ,对照组不采用预防性用药。两组均记录盆腔引流量及拔除引流管时间,检测并比较术前、术后d3、d7双下肢静脉血管和血流情况,术前和术后d1、d2、d5、d7血小板、凝血功能、D－二聚体（D-D）等指标。【结果】治疗组和对照组相比,术后盆腔引流量和拔管时间比较无显著性差异（P〉0．05）,术前与术后血小板、凝血功能比较无显著性差异（P〉0．05）;治疗组D-D术后d1达到高峰,对照组D-D在术后d3达到高峰,且高值持续时间大于治疗组。血管彩超结果：对照组术后d7有7例患者下肢静脉血栓形成;治疗组术后d7有2例下肢静脉微小血栓。两组病人均未发生肺栓塞。【结论】低分子肝素可降低妇科肿瘤术后下肢深静脉血栓发生率,且不会增加术后出血危险。     

两种预防人工关节置换术后下肢深静脉血栓形成方案的临床评价

[目的]评价两种不同预防人工关节置换术后下肢深静脉血栓形成( DVT)方案的效果及安全性.[方法] 40例人工膝、髋关节置换手术患者,随机分为两组,A组(n=19)予以术前12 h使用低分子肝素( LMWH)4250 IU,B组(n=21)则予以术后8h使用LMWH 4250 IU,两组均在麻醉开始时即应用间歇充气加压...     

Obstetrics and gynecology

Pregnancy has been recognized as a predisposing risk factor of deep venous thrombosis(DVT) and pulmonary thromboembolism(PTE). Recently, we investigated the incidence of PTE between 1991 and 2000 among 64 facilities of Obstetrics and Gynecology in Japan. As a result, incidences of PTE are 0.006% (14/227,318) in cases of vaginal delivery and 0.046%(25/54,277) in cases of cesarean section (CS) in Obstetrics. In Gynecology, they are 0.03% (34/106,598) in patients of benign tumors and 0.33%(54/16,206) in patients of malignant tumors. Classification of level of risks in Japanese subjects at present is thought to be as follows; cases of normal delivery and minor surgery are low risk, cases of CS and benign gynecological tumors are moderate risk, cases of CS with elderly fatty pregnant women and gynecological malignant tumors are high risk, and cases of CS or malignant tumors with thrombophilia or pre-DVT are the highest risk. Prophylaxis of DVT should be recommended early ambulation and adequate hydration in low risk cases, graduated compression stocking (GCS) or intermittent pneumatic compression (IPC) in moderate risk cases, IPC or the use of low-dose unfractionated heparin(LDUH) (and/or GCS) in high risk cases, and LDUH and IPC or LDUH and GCS in the highest risk cases.     

彩色多普勒超声诊断下肢深静脉血栓

目的与深静脉造影相比,探讨彩色多普勒超声对下肢深静脉血栓(DVT)的诊断价值。方法对80例临床疑诊下肢DVT患者行彩色多普勒超声与深静脉造影检查,对比分析检查结果。结果 80例可疑深静脉血栓患者中,彩色多普勒超声诊断65例下肢DVT,深静脉造影诊断64例;一致性检验显示两种方法的一致性好(Kappa值=0.80)。彩色多普勒超声诊断DVT的敏感度为96.88%(62/64),特异度为81.25%(13/16)。结论彩色多普勒超声诊断DVT具有较高的敏感度和特异度,可与深静脉造影相结合,作为诊断DVT的首选影像学方法。     

Prevention,treatment, and risk factors of deep vein thrombosis in critically ill patients in Zhejiang province,China: a multicenter,prospective, observational study

PurposeThe aim of this study is to investigate the prevention and treatment patterns of deep vein thrombosis (DVT) in critically ill patients and to explore the risk factors for DVT in people from Zhejiang Province, China.Materials and methodsThis study prospectively enrolled patients admitted in intensive care units (ICUs) of 54 hospitals from 09/16/2019 to 01/16/2020. The risk of developing DVT and subsequent prophylaxis was evaluated. The primary outcome was DVT occurrence during ICU hospitalisation. Univariate and multivariate logistic regression were performed to determine the risk factors for DVT.ResultsA total of 940 patients were included in the study. Among 847 patients who received prophylaxis, 635 (75.0%) patients received physical prophylaxis and 199 (23.5%) patients received drug prophylaxis. Fifty-eight (6.2%) patients were diagnosed with DVT after admission to the ICU, and 36 patients were treated with anticoagulants (all patients received low molecular weight heparin [LMWH]). D-dimer levels (OR = 1.256, 95% CI: 1.132–1.990), basic prophylaxis (OR = 0.092, 95% CI: 0.016–0.536), and physical prophylaxis (OR = 0.159, 95% CI: 0.038–0.674) were independently associated with DVT in ICU patients. The short-term survival was similar between DVT and non-DVT patients.ConclusionsDVT prophylaxis is widely performed in ICU patients. Prophylaxis is an independent protective factor for DVT occurrence. The most common treatment of DVT patients is LMWH, although it might increase the rate of bleeding.

Key messages

• This is the only multicenter and prospective study of DVT in ICUs in China.
• d-dimer levels were independently associated with DVT in ICU patients.
• Prophylaxis was an independent protective factor for DVT occurrence in ICU.

     

宫颈癌放疗后骨盆衰竭骨折MRI及相关临床特点分析

目的 探讨宫颈癌放疗后骨盆衰竭骨折的MRI特点、骨折率及相关因素。方法 收集176例具有完整临床及盆腔MRI资料的宫颈癌放疗后患者,分为衰竭骨折组及未骨折组,进行统计学分析。结果 176例中,发生骨盆衰竭骨折共15例(15/176,8.52%)。衰竭骨折组与未骨折组间宫颈癌首诊时年龄、月经状况、放疗治疗方式及是否适合手术治疗方面差异均有统计学意义(P均<0.05)。两组间体质量指数、FIGO分期、盆腔外放疗的辐射剂量、放疗结束至MR检查的时间间隔差异均无统计学意义(P均>0.05)。MRI示15例均累及骶骨,其中4例同时合并第1或2骶椎横行骨折,3例同时累及耻骨或髂骨。Kaplan-Meier曲线图示衰竭骨折5年累积发病率为31.80%。结论 宫颈癌放疗后骨盆衰竭骨折好发于骶骨,高龄和绝经状态是其主要危险因素。     

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUNDPulmonary thromboembolism (PTE) is a serious postoperative complication that can occur after a fracture. Generally, PTE is caused by the falling off of lower extremity deep vein thrombosis (LEDVT) after lower limb fracture surgery. LEDVT and PTE after upper extremity fracture surgery are very rare. PTE is one of the most common clinical causes of sudden death. Venous thromboembolism includes PTE and DVT. We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery. The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery, and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARYWe report a 51-year-old Chinese male who had severe fractures of the left distal ulna, radius and little finger after a motorcycle accident. The patient underwent external fixation, open reduction and internal fixation. On the third post-operative day, computed tomographic pulmonary angiography showed PTE. Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins. After a period of anticoagulation therapy, on the 25^th d after the PTE, computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared. Furthermore, about 4 mo after the PTE, thrombosis in the deep veins of the lower limbs disappeared. About 1 year after the surgery, X-rays showed good fracture healing, and the function of the wrist joint recovered well.CONCLUSIONThough rare, PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.     

超声评价高度可疑肺栓塞患者下肢深静脉血栓

目的 探讨超声检查对发现高度可疑肺栓塞(PE)患者合并有下肢深静脉血栓(DVP)的价值.方法 将161例临床及螺旋CT扫查高度可疑肺栓塞患者,按照是否有形成血栓危险因素和(或)深静脉血栓(DVT)症状分为两组.凡具有上述条件之一者为组1患者,共计118例;既无DVT症状也无危险因素者为组2,共计43例.所有患者均行超声检查.结果 超声检查发现组1有DVT者15例,其中发生在膝及膝以上者4例,发生在小腿者11例.组2无一例发现有DVT(95%可信度).组2在除外DVT的阴性预见性为100%(95%的可信度).结论 超声对发现高度可疑肺栓塞患者下肢DVT有重要价值.     

Establishment of a risk assessment score for deep vein thrombosis after artificial liver support system treatment

BACKGROUNDThe artificial liver support system (ALSS) is an effective treatment method for liver failure, but it requires deep venous intubation and long-term indwelling catheterization. However, the coagulation mechanism disorder of basic liver failure diseases, and deep venous thrombosis (DVT) often occur.AIMTo evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score.METHODSThis study was divided into three stages. In the first stage, the risk factors for DVT were screened and the patient data were collected, including ALSS treatment information; biochemical indices; coagulation and hematology indices; complications; procoagulant use therapy status; and a total of 24 indicators. In the second stage, a risk assessment score for DVT after ALSS treatment was developed. In the third stage, the DVT risk assessment score was validated.RESULTSA total of 232 patients with liver failure treated with ALSS were enrolled in the first stage, including 12 with lower limb DVT. Logistic regression analysis showed that age [odds ratio (OR), 1.734; P = 0.01], successful catheterization time (OR, 1.667; P = 0.005), activity status (strict bed rest) (OR, 3.049; P = 0.005), and D-dimer level (≥ 500 ng/mL) (OR, 5.532; P < 0.001) were independent risk factors for DVT. We then established a scoring system for risk factors. In the validation group, a total of 213 patients with liver failure were treated with ALSS, including 14 with lower limb DVT. When the cutoff value of risk assessment was 3, the specificity and sensitivity of the risk assessment score were 88.9% and 85.7%, respectively.CONCLUSIONA simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.