CAJ | 학술논문

目的回顾比较206例下肢闭合骨折患者术前并发深静脉血栓(deep vein thrombosis,DVT)的不同临床处理的临床意义.方法回顾性分析1 402例术前行患肢血管彩色多普勒血流显像(color doppler flow imaging,CDFI)检查的下肢闭合骨折并发DVT206例患者的临床处理情况.根据患者和家属(以下简称“患方”)的意见分4组:Ⅰ组13例,放弃手术保守治疗；Ⅱ组7例,溶栓治疗后手术,但3例溶栓失败；Ⅲ组6例,放置静脉滤网后手术；Ⅳ组180例,坚持术前不做处理要求手术治疗.结果 ①平均住院天数比较:Ⅰ组＞Ⅱ组＞Ⅲ组＞Ⅳ组,组间比较均P＜0.01.②Ⅱ组和Ⅲ组术中出血和术后渗血较多,均需输血治疗.③Ⅰ组出现腰骶部褥疮、肺部和尿路感染并发症共4例,余3组则无.④麻醉实施情况,腰硬联合阻滞122例(63.2％),实施气管插管全麻71例(36.8％).结论 ①下肢闭合骨折并发DVT患者坚持术前不做处理要求手术治疗,住院时间短、并发症少、患者满意度高,但麻醉手术工作者均面临着巨大的考验.②溶栓后和放置深静脉滤网后手术,术中出血和术后渗血均较多,术前应做好输血准备.③试探性分次给药单侧腰麻循环稳定、麻醉费用低、患者在麻醉恢复室停留时间短,有临床应用价值.
목적 회고비교206례하지폐합골절환자술전병발심정맥혈전(deep vein thrombosis,DVT)적불동림상처리적림상의의.방법 회고성분석1 402례술전행환지혈관채색다보륵혈류현상(color doppler flow imaging,CDFI)검사적하지폐합골절병발DVT206례환자적림상처리정황.근거환자화가속(이하간칭“환방”)적의견분4조:Ⅰ조13례,방기수술보수치료；Ⅱ조7례,용전치료후수술,단3례용전실패；Ⅲ조6례,방치정맥려망후수술；Ⅳ조180례,견지술전불주처리요구수술치료.결과 ①평균주원천수비교:Ⅰ조＞Ⅱ조＞Ⅲ조＞Ⅳ조,조간비교균P＜0.01.②Ⅱ조화Ⅲ조술중출혈화술후삼혈교다,균수수혈치료.③Ⅰ조출현요저부욕창、폐부화뇨로감염병발증공4례,여3조칙무.④마취실시정황,요경연합조체122례(63.2％),실시기관삽관전마71례(36.8％).결론 ①하지폐합골절병발DVT환자견지술전불주처리요구수술치료,주원시간단、병발증소、환자만의도고,단마취수술공작자균면림착거대적고험.②용전후화방치심정맥려망후수술,술중출혈화술후삼혈균교다,술전응주호수혈준비.③시탐성분차급약단측요마순배은정、마취비용저、환자재마취회복실정류시간단,유림상응용개치.
Objective To analyze the clinical effects of different therapy process to the patients with deep vein thrombosis (DVT) during reduction and internal fixation surgery of lower extremity closed fracture through retrospective study of 206 cases.Methods Retrospective study of 1 402 patients with lower limb close fracture,206 patients were found DVT by color doppler flow imaging(CDFI) in preoperative and were divided into four groups according to the choice of patients or their families.There were 13,7,6 and 180 patients in group Ⅰ,Ⅱ,Ⅲ,Ⅳ respectively.The patients in group Ⅰ received expectant treatments.The patients in group Ⅱ had chosen to have an operation after thrombolysis,but there were three patients failed.The patients in group Ⅲ had an operation after the filter of deep venous placed.The patients in group Ⅳ had requested surgery without any other treatment.Results ① There was significant difference in the average hospital stay among groups (group Ⅰ ＞group Ⅱ ＞groupⅢ＞groupⅣ,P＜0.01 ).②) The surgical hemorrhage in group H and group Ⅲ are more than that in group Ⅳ,and blood transfusion is needed.③ There were four cases of complications such as lumbosacral region bedsore,urinary tract infection and pneumonia in group Ⅰ.④ There were 122 cases (63.2％) finished the operation under combined spinal epidural anesthesia (CSEA),and 71 cases (36.8％) under tracheal intubation general anaesthesia (GA). Conclusions ① To operate for lower extremity closed fracture patients with deep vein thrombosis without preoperative treatment,there are more advantages such as shorter hospital stay,fewer complications and more satisfaction for the patients,but anesthesiologists will face more challenges because of more complicated clinical situations.② Theres more surgical hemorrhage because of preoperative thrombolysis treatment or placing filter of deep venous,and blood transfusion is needed.③ Unilateral spinal anesthesia is more advantageous when bupivacaine was given in subarachnoid space by low dosages.The hemodynamic of the patient is more stable,the expenditure is lower and there is shorter PACU stay.