间歇充气加压装置不同使用模式对预防直肠癌腹腔镜术中患者静脉血栓的效果

doi:10.3761/j.issn.0254-1769.2022.06.008

摘要/Abstract

摘要：

目的探讨腹腔镜直肠癌手术患者术中不同模式间歇充气加压装置（intermittent pneumatic compression,IPC）预防下肢深静脉血栓（deep vein thrombosis,DVT）的效果。方法 2020年4月—2021年4月,在温州市某三级甲等医院结直肠外科连续选择符合纳入标准的130例拟行腹腔镜直肠癌根治术患者作为研究对象。采用随机数字表法分为对照组、试验组Ⅰ、试验组Ⅱ、试验组Ⅲ。对照组围手术期采用常规护理方法预防下肢DVT。各试验组在对照组基础上,手术全程采用对应的IPC模式预防下肢DVT。试验组Ⅰ采用IPC双足模式,足底气囊加压130 mmHg（1 mmHg=0.133 kPa）,持续6 s,放松12 s。试验组Ⅱ采用IPC双小腿模式,气囊于小腿序贯加压80 mmHg,持续12 s,放松24 s。试验组Ⅲ采用IPC双小腿+大腿模式,气囊分别从足踝、小腿、大腿部位序贯加压80、70、60 mmHg,持续24 s,放松24 s。比较4组麻醉诱导前和拔管后双下肢静脉血流动力学变化及术后血栓发生率。结果与对照组相比,试验组Ⅰ和试验组Ⅱ：麻醉诱导前和拔管后,双侧股总静脉、股浅静脉、腘静脉的血流速度变化率差异有统计学意义（P<0.05）,管径变化率差异无统计学意义（P>0.05）。术后第1天下肢DVT发生率明显下降,差异有统计学意义（P=0.039,P=0.042）。与对照组相比,试验组Ⅲ：麻醉诱导前和拔管后,双侧股总静脉血流速度变化率差异无统计学意义（P>0.05）,各静脉管径变化率差异均无统计学意义（P>0.05）。术后第1天下肢DVT发生率无改善,差异无统计学意义（P=0.820）。4组术后第7天血栓发生率差异均无统计学意义（P=0.125）。结论术中IPC足模式和IPC小腿模式均能改善下肢血流动力学,预防腹腔镜直肠癌患者术后第1天血栓发生,且效果相近。

关键词: 腹腔镜, 直肠肿瘤, 间歇性充气加压装置, 血流动力学, 静脉血栓形成, 护理

Abstract:

Objective To investigate the effects of different modes of intermittent pneumatic compression（IPC） in preventing deep vein thrombosis（DVT） in patients undergoing laparoscopic rectal cancer surgery.Methods From April 2020 to April 2021,130 patients for laparoscopic radical rectal cancer surgery（Dixon） were sequentially selected in a tertiary hospital,and they were divided into the control group,group Ⅰ,group Ⅱ,and groupⅢ by random number table method. The control group were routinely treated to prevent thrombosis during perioperative period,and other groups were treated with corresponding IPC mode during the operation on the basis of the treatment in the control group. Specifically,group Ⅰ adopted the IPC bipedal mode,and the plantar airbag was applied to 130 mmHg for 6 s,and then relaxed for 12 s. Group Ⅱ adopted the IPC double calf model,and the airbag was applied to the calf sequentially by 80 mmHg for 12 s and relaxed for 24 s. Group Ⅲ adopted IPC double calf + thigh mode,and airbags sequentially pressed 80 mmHg,70 mmHg and 60 mmHg from the ankle,calf and thigh respectively for 24 s and relaxed for 24 s. The venous hemodynamic changes of the lower extremities and the incidence of DVT in the 4 groups were compared before and after operation.Results Compared with the control group,group Ⅰ and group Ⅱ have statistically significant differences in the velocity rates of bilateral femoral common,superficial and popliteal veins before and after surgery（P<0.05）,while there is no difference in the change of blood vessel caliber. The incidences of DVT on the first day were improved significantly（P=0.039,P=0.042）,respectively. Compared with those in the control group,there were no significant difference in the velocity rates of bilateral total femoral veins,as well as the change of blood vessel caliber of bilateral common femoral vein,superficial femoral vein and popliteal vein in the group Ⅲ（P>0.05）. The incidence of DVT on the first day after surgery was not improved（P=0.820）. There were no statistically significant differences in the incidences of DVT between the 4 groups on the 7th day after surgery（P=0.125）.Conclusion Both the IPC foot mode and the IPC leg mode can reduce the incidence of DVT on the first day after laparoscopic rectal cancer surgery with similar efficacy.

Key words: Laparoscope, Rectal Neoplasms, Intermittent Gas Compression Device, Hemodynamics, Venous Thrombosis, Nursing Care

施若霖, 张丽青, 孙捷豪, 翁成杰, 郭城楠, 孙彩霞, 潘贻飞, 谢作流, 王明山, 卢中秋. 间歇充气加压装置不同使用模式对预防直肠癌腹腔镜术中患者静脉血栓的效果[J]. 中华护理杂志, 2022, 57(6): 695-702.

SHI Ruolin, ZHANG Liqing, SUN Jiehao, WENG Chengjie, GUO Chengnan, SUN Caixia, PAN Yifei, XIE Zuoliu, WANG Mingshan, LU Zhongqiu. Study on the effects of different modes of intermittent pneumatic compression during operation in preven-tion of venous thrombosis of the lower extremities after rectal cancer surgery[J]. Chinese Journal of Nursing, 2022, 57(6): 695-702.

图/表 4

表1 4组一般资料比较

Table 1 Comparison of baseline variables of four groups

表2 4组麻醉诱导前和拔管后不同部位血液峰速、均速的变化率的比较

Table 2 Comparison of the change rates of peak and mean velocities in different sites of venous vessels before and after surgery

表3 4组麻醉诱导前和拔管后不同部位静脉管径变化率比较

Table 3 Comparison of the change rates in venous diameter at different sites before and after surgery

表4 4组术后第1天、第7天深静脉血栓发生率的比较

Table 4 Comparison of the thrombosis incidence in the four groups on postoperative day 1 and day 7

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