CAJ | 학술논문

目的探讨间歇充气加压装置(intermittent pneumatic compression,IPC)联合药物抗凝治疗预防髋、膝关节置换术后下肢深静脉血栓(deep vein thrombosis, DVT)的临床疗效.方法 400例患者纳入前瞻性随机对照研究,联合抗凝组(药物联合IPC抗凝治疗)与药物抗凝组(单纯药物抗凝治疗)各200例患者,分别包括100例全髋关节置换(total hip ar-throplasty,THA)患者和100例全膝关节置换(total knee arthroplasty,TKA)患者.所有手术均在全身麻醉下进行.药物抗凝组患者术后单纯口服选择性Xa因子抑制剂(利伐沙班)抗凝治疗,联合抗凝组患者从术中开始采用IPC联合选择性Xa因子抑制剂(利伐沙班)抗凝治疗预防术后DVT.术后第2天行双下肢深静脉彩色多普勒超声检查,明确有无DVT发生,分别记录近端DVT(腘窝静脉分叉处)、远端DVT(胫前静脉、胫后静脉或腓静脉)及肌间DVT,对怀疑肺栓塞的患者行CT肺动脉造影检查明确诊断.结果术后下肢总DVT的发生率、近端DVT发生率、远端DVT发生率及肌间DVT发生率联合抗凝组分别为9.5％、0.5％、0.5％和8.5％,药物抗凝组为分别为30％、0.5％、5.5％和24％,两组患者均无症状性肺栓塞发生.联合抗凝组术后DVT总体发生率、远端DVT和肌间静脉血栓发生率均明显低于药物抗凝组.联合抗凝组TKA患者、THA患者DVT发生率较药物抗凝组均明显降低.发生DVT的患者停用IPC,将抗凝药物(利伐沙班)改为依诺肝素进行抗凝,近端血栓及远端血栓患者卧床、患肢制动,肌间静脉血栓患者正常下床康复锻炼.术后10～12 d复查彩色多普勒超声显示血栓均溶解消失.结论 IPC联合利伐沙班抗凝治疗与单用利伐沙班抗凝治疗相比能够明显降低髋、膝关节置换术后早期下肢远端DVT的发生率.
목적 탐토간헐충기가압장치(intermittent pneumatic compression,IPC)연합약물항응치료예방관、슬관절치환술후하지심정맥혈전(deep vein thrombosis, DVT)적림상료효.방법 400례환자납입전첨성수궤대조연구,연합항응조(약물연합IPC항응치료)여약물항응조(단순약물항응치료)각200례환자,분별포괄100례전관관절치환(total hip ar-throplasty,THA)환자화100례전슬관절치환(total knee arthroplasty,TKA)환자.소유수술균재전신마취하진행.약물항응조환자술후단순구복선택성Xa인자억제제(리벌사반)항응치료,연합항응조환자종술중개시채용IPC연합선택성Xa인자억제제(리벌사반)항응치료예방술후DVT.술후제2천행쌍하지심정맥채색다보륵초성검사,명학유무DVT발생,분별기록근단DVT(객와정맥분차처)、원단DVT(경전정맥、경후정맥혹비정맥)급기간DVT,대부의폐전새적환자행CT폐동맥조영검사명학진단.결과 술후하지총DVT적발생솔、근단DVT발생솔、원단DVT발생솔급기간DVT발생솔연합항응조분별위9.5％、0.5％、0.5％화8.5％,약물항응조위분별위30％、0.5％、5.5％화24％,량조환자균무증상성폐전새발생.연합항응조술후DVT총체발생솔、원단DVT화기간정맥혈전발생솔균명현저우약물항응조.연합항응조TKA환자、THA환자DVT발생솔교약물항응조균명현강저.발생DVT적환자정용IPC,장항응약물(리벌사반)개위의낙간소진행항응,근단혈전급원단혈전환자와상、환지제동,기간정맥혈전환자정상하상강복단련.술후10～12 d복사채색다보륵초성현시혈전균용해소실.결론 IPC연합리벌사반항응치료여단용리벌사반항응치료상비능구명현강저관、슬관절치환술후조기하지원단DVT적발생솔.
Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) devices combined with anticoagulants for the prevention of deep vein thrombosis (DVT) after joint replacement surgery.Methods All of 400 patients were involved in this prospective randomized control study with 100 total knee arthroplasty (TKA) patients and 100 total hip arthroplasty (THA) patients in each group.All patients were operated under the general anesthesia.Patients in the control group received 10 mg of rivaroxaban per day beginning 6-8 hours after the surgery.Besides the prescription of rivaroxaban, IPC devices were used just after the anesthesia in the operating theater and lasted for 48 hours in the experimental group.The diagnosis of DVT in the lower extremities was made by color Duplex sonography on the second postoperative day.The incidence rate of DVT and symptomatic pulmonary embolism was recorded.The incidence rates of total DVT, proximal DVT (p-DVT, proximal to the trifurcation of the popliteal vein), distal DVT (d-DVT, in the anterior tibial vein, posterior tibial vein or peroneal vein) and intermuscular DVT were recorded.CT pulmonary angiography was used to confirm the pulmonary embolism if it was suspected.Results The incidence rates of overall, proximal, distal and intermuscular DVT were 9.5％, 0.5％, 0.5％, 8.5％ in the experimental group and 30％, 0.5％, 5.5％, 24％ in the control group respectively.The incidence rates of total DVT, distal DVT and intermuscular DVT were significantly lower in the experimental group.The incidence rate of DVT in TKA patients and THA patients were significantly lower in the experimental group than in the control group respectively.For patients with DVT, enoxaparin was used instead of rivaroxaban, and DVT was found disappeared by color Duplex sonography 10-12 days postoperatively.Conclusion Compared with the use of rivaroxaban alone, IPC devices combined with anticoagulants can significantly reduce the incidence rate of distal DVT and intermuscular DVT in the early postoperative period after joint replacement surgery.