间歇充气加压与低分子肝素预防内科ICU高危病人下肢DVT的临床观察

目的探讨间歇充气加压（IPC）与低分子肝素（LMWH）预防内科高危病人下肢深静脉血栓（DVT）的效果和安全性。方法选取静脉血栓栓塞高风险病人100例，随机分为4组:IPC组、LMWH组、IPC+LMWH组和空白对照组。于治疗前及治疗后第1、4、7天，行下肢彩色多谱勒检查，观察各组腘静脉和股静脉的血流速度，判断是否存在血栓，同时检测活化部分凝血活酶时间（APTT）、血栓弹力图，比较各组发生下肢DVT的例数及不良事件。结果治疗前各治疗组与空白对照组APTT、血栓弹力图各指标差异均无统计学意义（P>0.05），治疗后各组APTT、血栓弹力图各指标与治疗前之间的差异均无统计学意义（P>0.05），治疗后各治疗组与空白对照组比较，APTT、血栓弹力图各指标的差异均无统计学意义（P>0.05）。各组治疗前腘静脉、股静脉平均血流速度差异均无统计学意义（P>0.05）；与治疗前相比，IPC组及IPC+LMWH组平均血流速度增快（P < 0.01），LMWH组与对照组平均血流速度均无明显变化（P>0.05）。IPC组发生下肢DVT 2例（8%），LMWH组2例（8%），IPC+LMWH组1例（4%），空白对照组8例（32%），各治疗组DVT发生率均低于对照组（P < 0.05~P < 0.01）。各组均未发生出血不良反应。结论应用IPC与低分子肝素是安全、有效地预防内科高危病人下肢DVT的方法。

Clinical observation on intermittent pneumatic compression and low-molecular-weight heparin in the prevention of lower extremity deep venous thrombosis in medical ICU patients with high risk

Objective To explore the safety and effect of intermittent pneumatic compression(IPC) and low-molecular-weight heparin(LMWH) in the prevention of lower extremity deep venous thrombosis(DVT) medical ICU patients with high risk.Methods A total of 100 medical ICU patients with high-risk venous thromboembolism were selected and randomly divided into 4 groups: IPC group, LMWH group, IPC+LMWH group and control group.Before treatment and on the first day, the fourth day, and the seventh day after the treatment, the patients were tested with the color Doppler examination to determine the blood flow velocity of popliteal vein and femoral vein, and the thrombus was detected.Simultaneously, activated partial thromboplastin time (APTT) and thromboelastogram were detected.The number of lower extremity DVT and adverse events in each group were compared.Results There was no significant difference in the indexes of APTT, thromboelastogram between each treatment group and the control group before treatment (P>0.05), there was no significant difference in the indexes of APTT, thromboelastogram in each group between after treatment and before treatment(P>0.05), and there was no significant difference in the indexes of APTT, thromboelastogram between each treatment group and the control group after treatment (P>0.05).There was no significant difference in mean blood flow velocity of popliteal vein and femoral vein in each group before treatment(P>0.05).After treatment, the mean blood flow velocity in IPC group and IPC+LMWH group was faster than that in control group(P < 0.01).The mean blood flow velocity in IPC group and IPC+LMWH group was faster than that before treatment (P < 0.05).There were 2 cases (8%) of lower extremity DVT in IPC group, 2 cases(8%) of lower extremity DVT in LMWH group, 1 case(4%) of lower extremity DVT in IPC+LMWH group, 8 cases (32%) of lower extremity DVT in control group, the incidence of DVT in each treatment group was lower than that in control group(P < 0.05 to P < 0.01), bleeding adverse reaction did not happen in each group during treatment.Conclusions IPC and LMWH are safe and effective methods to prevent lower extremity DVT in high-risk patients.