CAJ | 학술논문

目的：比较全膝关节置换术（TKR）后多模式防治策略与传统防治措施预防术后深静脉血栓形成（DVT ）的效果，探讨TKR预防DVT的有效方法。方法收集2011年7月至2013年6月该院行TKR患者289例，2012年7月前的137例患者为A组，术后采用传统的DV T预防措施；2012年7月以后的152例患者为B组，术后固定采用序贯、交叉的联用低分子肝素、间歇式充气压力治疗及持续股神经阻滞镇痛的多模式预防策略。比较两组患者术后DV T发生率、分布部位以及两组患者年龄、性别构成、体质量指数、疾病种类、手术时间、手术出血量、术中输血、输液量和术后引流量。结果 B组患者术后DV T发生率明显低于A组，差异有统计学意义（P＜0．05），两组患者中发生的DVT 在近端、远端静脉分布构成比方面差异无统计学意义（P＞0．05）。结论与传统防治措施相比，TKR后采用序贯、交叉的联用低分子肝素、间歇式充气压力治疗及持续股神经阻滞镇痛的多模式预防策略，可以更加有效地预防术后DV T的发生。
목적：비교전슬관절치환술（TKR）후다모식방치책략여전통방치조시예방술후심정맥혈전형성（DVT ）적효과，탐토TKR예방DVT적유효방법。방법수집2011년7월지2013년6월해원행TKR환자289례，2012년7월전적137례환자위A조，술후채용전통적DV T예방조시；2012년7월이후적152례환자위B조，술후고정채용서관、교차적련용저분자간소、간헐식충기압력치료급지속고신경조체진통적다모식예방책략。비교량조환자술후DV T발생솔、분포부위이급량조환자년령、성별구성、체질량지수、질병충류、수술시간、수술출혈량、술중수혈、수액량화술후인류량。결과 B조환자술후DV T발생솔명현저우A조，차이유통계학의의（P＜0．05），량조환자중발생적DVT 재근단、원단정맥분포구성비방면차이무통계학의의（P＞0．05）。결론여전통방치조시상비，TKR후채용서관、교차적련용저분자간소、간헐식충기압력치료급지속고신경조체진통적다모식예방책략，가이경가유효지예방술후DV T적발생。
Objective To explore the more effective measures for the prevention of deep vein thrombosis (DVT ) by comparing the different efficacy between the multimodal strategy and liberal measures .Methods From July 2011 to June 2013 ,medical records of 289 patients who had accepted total knee replacement (TKR) were collected .Patients were divided into two groups according to whether exploring to the multimodal strategy or liberal measures after TKR .The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,intermittent pneumatic compression ,and postoperative continues femoral nerve block analgesia .Patients in group A were treated during July 2011 to June 2012 ,and accepted liberal measures for the prevention of DVT .Patients in group B were treated after June 2012 ,and accepted multimodal strategy .The data of each group were collected for statistical analysis on the following aspects :DVT occurrence rate ,DVT distribution ,age ,gender ,body mass index ,disease ,operation duration ,volume of blood loss and transfusion during operation phase ,drainage volume after TKR .Results The DVT occurrence rate of patients in group B were significantly lower than that of patients in group A (P<0 .05) .No significant difference were foun-ded in the DVT distribution between the two groups(P>0 .05) .Conclusion The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,postoperative low molecular weight heparin ,and postoperative continues femoral nerve block analgesia is more effective than liberal measures for the prevention of DVT .