人工髋膝关节置换术后下肢深静脉血栓的预防.docx

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人工髋膝关节置换术后下肢深静脉血栓的预防

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【摘要】目的探讨人工髋关节和膝关节置换术后深静脉血栓（下肢深静脉血栓形成,DVT）的预防措施。方法30例拟接受髋膝关节手术的患者行彩色多普勒超声检测，双下肢无深静脉血栓形成，术后采用1、利伐沙班2、低分子肝素分别抗凝治疗为主、机械预防措施为辅的方法。术后3d再次给予彩色超声多普勒检查，必要时合并下肢深静脉造影，确诊为腘静脉以上的DVT，给予溶栓或手术治疗。结果术后5例形成DVT，发生率为16.67%，均无症状性肺栓塞。结论人工髋膝关节置换术前要优先使患者合并症得到有效治疗，术中采用全麻或腰硬联合麻醉，术后给予利伐沙班或低分子肝素同时联合机械预防的方法，可以有效的预防术后DVT的发生率。

【关键词】人工髋膝关节置换术深静脉血栓发生率

【中图分类号】R543.6【文献标识码】A【文章编号】1672-5085（2014）07-0068-02

ThepreventionofdeepvenousthrombosisafterhipandkneearthroplastyLIUMing-junWANGJun-yi.

DepartmentofOrthopetics,PuyangPeople’sHospital,Puyang457000,China

【Abstract】ObjectiveToexplorethepreventionofdeepvenousthrombosis（DVT）afterhipandkneearthroplasty.Methods30casesintendinghipandkneereplacementwerediagnosedusingultrasoundandcolordopplerflowimagingandtherewerenothrombosisindeepveinsoflowerlimbs.Lowmolecularweightheparinorrivaroxabanweregivenrespectivelytoanticoagulanttherapyafterthesurgeryandmechanicalpreventivemeasureswereusedadjuvantly.Ultrasoundandcolordopplerflowimagingwerediagnosedcombinedwithdeepveinangiographywhennecessarythreedaysaftertheoperation，andthrombolysisorsurgerytherapywereappliedtowhomdefinitelydiagnosedDVTabovethepoplitealvein.ResultsFivepatientsweresufferedfromDVT,theincidencewas16.67%andtherewerenosymptomaticpulmonaryembolism.ConclusiontherearethreekeypointstopreventtheoccurrenceofDVTinhipandkneearthroplasty：preoperativeeffectivetreatmentshouldbegiventothepatientstorelievethecomplications，generalanesthesiaorcombinedspinalepiduralanesthesiawereusedduringtheoperation，andthenlowmolecularweightheparinorrivaroxabanwereappliedrespectivelycombinedwithmechanicalpreventivemeasurestoanticoagulanttherapyafterthesurgery.

【Keywords】Hipandkneearthroplasty;Deepvenousthrombosis;Incidencerate

1.分组与预防治疗方法

1.1分组:根据DVT的威尔氏首诊临床(Well’)评分分为疑似DVT(≥2分)组20例和非疑似

VT(2分)组10例，Well’S评分指标见表1。

表1DVT的Well/s评分

再根据患者病情且在其知情同意的情况下，将疑似DVT组和非疑似DVT组随机分为2组：(1)利伐沙班组；(2)低分子肝素组；以上2组均给予辅助机械预防措施。

1.2:DVT的监测：术前和术后3d应用彩色超声多普勒仪测定，如呈阳性者行下肢深静脉造影，确诊为腘静脉以上的DVT，进一步分析后，给予溶栓或手术治疗。

1.3预防治疗方法

(1)利伐沙班组（拜瑞妥胶囊）：