CAJ | 학술논문

目的：观察并探讨下肢血液循环泵联合利伐沙班预防下肢关节置换术后静脉血栓形成的临床效果。方法选取关节科2012年7月至2014年1月收治的行全髋（膝）关节置换术患者70例，按随机数字表法分为观察组（37例）和对照组（33例）。对照组术后予基础护理+利伐沙班抗凝处理，观察组在对照组基础上加用下肢血液循环泵，每日2次，连续使用10~14 d，对比两组术后2，7 d 凝血功能、下肢周径，并观察深静脉血栓（DVT）发生率。结果观察组术后2 d 凝血活酶时间（APTT）[（34.3±5.8）s 比（30.2±4.6）s]，术后7 d凝血酶原时间（PT）[（15.9±3.5）s 比（14.3±3.1）s]、APTT[（36.8±5.3）s 比（34.3±4.9）s]均长于对照组（ t1=3.250，t2=2.014，t3=2.041，P <0.05）；术后2 d 观察组与对照组大腿周径[（47.5±4.1）cm 比（49.6±4.5）cm]，小腿周径[（37.2±2.9）cm 比（38.7±3.3）cm]；术后7 d 两组大腿周径[（46.2±4.0）cm 比（48.2±3.8）cm]、小腿周径[（36.2±2.7）cm 比（37.6±2.5）cm]，差异均有统计学意义（ t1=2.043，t2=2.024，t3=2.138，t4=2.242，P <0.05）。观察组术后下肢 DVT 发生率8.11%(3/37）明显低于对照组水平27.27%(9/33，χ2=4.510，P =0.034）。结论血液循环泵能通过改善下肢血流，增加纤溶活性，发挥抗凝作用，联合利伐沙班可有效预防下肢关节置换术后下肢 DVT 的发生。
목적：관찰병탐토하지혈액순배빙연합리벌사반예방하지관절치환술후정맥혈전형성적림상효과。방법선취관절과2012년7월지2014년1월수치적행전관（슬）관절치환술환자70례，안수궤수자표법분위관찰조（37례）화대조조（33례）。대조조술후여기출호리+리벌사반항응처리，관찰조재대조조기출상가용하지혈액순배빙，매일2차，련속사용10~14 d，대비량조술후2，7 d 응혈공능、하지주경，병관찰심정맥혈전（DVT）발생솔。결과관찰조술후2 d 응혈활매시간（APTT）[（34.3±5.8）s 비（30.2±4.6）s]，술후7 d응혈매원시간（PT）[（15.9±3.5）s 비（14.3±3.1）s]、APTT[（36.8±5.3）s 비（34.3±4.9）s]균장우대조조（ t1=3.250，t2=2.014，t3=2.041，P <0.05）；술후2 d 관찰조여대조조대퇴주경[（47.5±4.1）cm 비（49.6±4.5）cm]，소퇴주경[（37.2±2.9）cm 비（38.7±3.3）cm]；술후7 d 량조대퇴주경[（46.2±4.0）cm 비（48.2±3.8）cm]、소퇴주경[（36.2±2.7）cm 비（37.6±2.5）cm]，차이균유통계학의의（ t1=2.043，t2=2.024，t3=2.138，t4=2.242，P <0.05）。관찰조술후하지 DVT 발생솔8.11%(3/37）명현저우대조조수평27.27%(9/33，χ2=4.510，P =0.034）。결론혈액순배빙능통과개선하지혈류，증가섬용활성，발휘항응작용，연합리벌사반가유효예방하지관절치환술후하지 DVT 적발생。
Objective To eXplore the clinical efficacy of the lower limb blood circulation pump combined with rivaroXaban in preventing deep venous thrombosis(DVT) after lower limb arthroplasty. Methods 70 cases of total hip (knee) replacement (THR / TKR) in our department from July 2012 to January 2014 were selected as the study subjects and randomly divided into the observation group (37 cases) and the control group (33 cases) according to the random numbers. The control group was given the basic nursing and rivaroXa-ban for conducting the anticoagulation treatment after THR or TKR surgery, while on this basis the observation group was added with the lower limb blood circulation pump, twice a day for continuous 10 - 14 d. The coagulation function and the lower limb circumference on postoperative 2, 7 d were compared between the two groups and the occurrence rate of DVT in 2 groups was also observed. Results The activated partial thromboplastin time (APTT) on postoperative 2 d in the observation group was longer than that in the control group[ (34. 3 ± 5. 8 ) s vs. (30. 2 ± 4. 6) s]; the same differences on postoperative 7 d also were seen in the prothrombin time (PT) [ (15. 9 ± 3. 5) s vs. (14. 3 ± 3. 1) s] and APTT [ (36. 8 ± 5. 3) s vs. (34. 3 ± 4. 9) s], the differences were all statistically significant( t1 =3. 250,t2 = 2. 014,t3 = 2. 041, P < 0. 05). The thigh circumference on postoperative 2 d in the observation group and the control group was (47. 5 ± 4. 1) cm vs. (49. 6 ± 4. 5) cm, the calf circumference was (37. 2 ± 2. 9) cm vs. (38. 7 ± 3. 3) cm, which on postoperative 7 d were (46. 2 ± 4) cm vs. (48. 2 ± 3. 8) cm and (36. 2 ± 2. 7) cm vs. (37. 6 ± 2. 5) cm, all the lower limb circumference indeXes after operation had statistically significant differences( t1 = 2. 043, t2 = 2. 024, t3 = 2. 138, t4 = 2. 242, P < 0. 05) . The occurrence rate of postoperative lower limb DVT in the observation group was 8. 11% (3 / 37), which was significantly lower than 27. 27% (9 / 33) in the control group( χ2 = 4. 510, P =0. 034). Conclusion The blood circulation pump can play the anticoagulation role by improving the lower limb blood flow and increasing the fibrinolytic activity , its combination with rivaroXaban can effectively preventing lower limb DVT after lower limb arthroplasy.