间歇充气加压装置不同使用时长对预防腰椎融合术中患者静脉血栓的效果评价

doi:10.3761/j.issn.0254-1769.2022.04.010

摘要/Abstract

摘要：

目的探讨腰椎融合术术中间歇充气加压装置不同使用时长对深静脉血栓和血流动力学的影响。方法采用便利抽样方法,选取2020年6月—2021年3月在郑州市某三级甲等医院脊柱外科择期行腰椎融合术患者61例,按照随机数字表法分为试验组和对照组。在给予常规护理的基础上,两组均于手术开始即刻启用间歇充气加压装置,均使用2次,且2次间隔15 min,试验组每次使用时长为40 min,对照组每次使用时长为30 min,比较两组术后深静脉血栓发生率、凝血指标、血流动力学和术中出血量的变化。结果最终纳入60例患者。两组术后均无症状性深静脉血栓形成,彩超提示,试验组1例（3.3%）、对照组2例（6.7%）有肌间静脉血栓形成,差异无统计学意义（χ²=0.351,P=0.554）。重复测量方差分析结果显示,纤维蛋白原和股总静脉血流峰速的时间效应、组间与时间的交互作用、分组效应差异均具有统计学意义（F_时间=222.466和45.899,P_时间均<0.001;F_交互=12.707和4.873,P_交互<0.001和=0.009;F_组间=10.052和43.975,P_组间=0.002和0.008）。两组术中出血量比较,差异无统计学意义（t=0.189,P=0.851）。结论腰椎融合术术中使用间歇充气加压装置每次40 min、共2次在促进纤维蛋白原溶解、加快股静脉血流峰速方面优于每次30 min、共2次,可有效改善血液高凝状态,降低了术中形成深静脉血栓的风险。

关键词: 腰椎融合术, 术中, 间歇充气加压装置, 使用时长, 深静脉血栓, 基础护理

Abstract:

Objective To investigate the effect of applying the intermittent pneumatic compression devices（IPCD）with different duration on hemodynamics of deep venous thrombosis（DVT） during lumbar fusion surgery. Methods Using the convenient sampling method,a total of 61 patients who received lumbar fusion surgery in the spinal surgery department of a tertiary A hospital in Zhengzhou from June 2020 to March in 2021 were randomly divided into an experimental group and a control group. On the basis of the routine nursing care,the patients in both groups started to use the IPCD immediately after the surgery. 2 groups both employed it twice with the interval time of 15 minutes. The duration of application was for 30 minutes in the control group and 40 minutes in the experimental group respectively. The incidence of DVT,coagulation indexes,hemodynamics and intraoperative blood loss were compared between the 2 groups. Results Finally,a total of 60 patients were included. There was no symptomatic deep venous thrombosis in the 2 groups,but 2 cases（6.7%） in the control group and 1 case（3.3%）in the experimental group had intramuscular venous thrombosis,with no statistical difference（ χ²=0.351,P=0.554）. The results of repeated measurement analysis of variance on patients’ coagulation indexes and hemodynamics showed that the time effect of fibrinogen and femoral vein peak velocity,the interaction between groups and time,and the grouping effect were statistically significant,respectively（F_time=222.466 and 45.899,P_time<0.001;F_interactive=12.707 and 4.873,P_interactive<0.001 and=0.009;F_{between groups}=10.052 and 43.975,P_{between groups}=0.002 and 0.008）. There was no significant difference in intraoperative blood loss between the 2 groups（t=0.189,P=0.851）. Conclusion The use of IPCD during lumbar fusion surgery for 40 minutes is much better than 30 minutes each time,for twice in total in promoting fibrinogen dissolution and accelerating the peak velocity of femoral vein blood. It can effectively improve the blood hypercoagulability and reduce the risk factors of intraoperative DVT.

Key words: Lumbar Fusion Surgery, Intraoperative, Intermittent Pneumatic Compression Devices, Duration, Deep Vein Thrombosis, Basic Nursing

范志英, 焦文仓, 王亚红, 张会敏, 郑喜灿. 间歇充气加压装置不同使用时长对预防腰椎融合术中患者静脉血栓的效果评价[J]. 中华护理杂志, 2022, 57(4): 449-454.

FAN Zhiying, JIAO Wencang, WANG Yahong, ZHANG Huimin, ZHENG Xican. Intervention study of applying intermittent pneumatic compression devices with different duration in lumbar fusion surgery[J]. Chinese Journal of Nursing, 2022, 57(4): 449-454.

图/表 3

表1 两组一般资料的比较

Table 1 Comparison of general data between the two groups

表2 两组不同时间点D-二聚体浓度、纤维蛋白原浓度及血小板计数比较（$\bar{x}\pm s$）

Table 2 Comparison of D-dimer,fibrinogen and platelet levels at different time points between the two groups（$\bar{x}\pm s$）

表3 两组不同时间点股总静脉、腘静脉血流峰速的比较（cm/s,$\bar{x}\pm s$）

Table 3 Comparative analysis of peak velocity of common femoral vein and popliteal vein at different time points between the two groups（cm/s,$\bar{x}\pm s$）

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