周期性充气加压预防子宫切除术后下肢深静脉血栓的研究

1、周期性充气加压预防子宫切除术后下肢深静脉血栓的研究        【中文摘要】下肢深静脉血栓(deep venous thrombosis,DVT)是外科手术常见的并发症之一。在外科不同种类手术后DVT的患者中,妇产科患者占14%-19%。子宫切除术是妇科最常见的手术之一,下肢深静脉血栓是该手术后非常危险的并发症。通过查阅国内外文献所做的大样本调查发现妇科恶性肿瘤术后下肢深静脉血栓的发生率明显高于良性肿瘤患者。目前手术后下肢深静脉血栓的预防由于缺乏确切的临床证据而没有同一的治疗标准,因此探讨有效的预防子宫切除术后下

2、肢深静脉血栓的方法是很有必要的。下肢深静脉血栓治疗比较复杂,患者随时都有危险存在,并且治疗时间也较长,因此围手术期的预防尤为重要。当前观点以为应用化学性方法如小剂量应用低分子肝素来预防DVT的效果是肯定的,但预防的同时也存在出血、血肿等并发症的危险。因此无创型的物理预防方法逐渐备受关注。但目前能够确切说明物理性预防措施在子宫切除术后DVT形成中的效果及临床应用远景的资料很少。为了更好地预防子宫切除术后下肢深静脉血栓的发生,本研究旨在寻求更加公道有效的预防下肢深静脉血栓的物理方法。将使用周期性充气加压系统的患者作为实验组,未使用周期性充气加压系统的患者作为对照组,用秩和检验比较实验组和对照组患者

3、DVT发生情况的差异。');【Abstract】 Objective:At present, there is no treatment standard of the way to preventing the deep vein thrombosis post-traumatic. It is because of no convincing evidence.We have to look for more effective methods to prevent DVT. It is necessary to search for effective approaches to

4、 prevent deep vein thrombosis after hysterectomy.It is complication to treat deep venous thrombosis. The risk exists at any time. Itstreatment time is longer. So we take methods to prevent DVT during the period of operation becomes more important. Up to now, the effects of chemical mathods such as t

5、aking small dose of low molecular weight heparin has been affirmed. But the complications are also co-exist in itself, such as bleeding, hematoma. Therefore non-invasive physical methods of prevention have been of concerned. However, there is little information about the effects and clinical applica

6、tions of the prevention of deep venous thrombosis. In this study, gynecological benign and maligant patients were divided into two grous: IPCS Group and artificial massage Group. Then I did the clinical control study. According to the results of color Doppler, I formulated the efficacy standards. At

7、 last observated the clinical effects of IPCS in the prevention of DVT after gynecological hysterectomy.Methods:In the research, the patients from gynecological of China-Japan Hospital of Jilin University from January to October in 2008.They all undergone hysterectomy. They included 63 cases of pati

8、ents with maligant tumors,65cases of benign tumor patients. I selected 63 patients with maligant tumor after hysterectomy randomly. Then divided them into Groups A and B,31 case of GroupA, Group B 32 cases; I selected 65 patients with benign tumor after hysterectomy randomly. Then divided them into

9、Groups C and D,32cases of Group C and Group D with 33cases.For Group A and Group C,I did health guidance during the period of the operation to the patients and their family. At the same time, gave a botom-up massage of the gastrocnemins and soleus muscle of lower limb to the patients and let them ac

10、tive the ankle joint. For B and D Groups, I not only use the ways A and C Groups has been used but also use the intermittent pneumatic compression systems.Health guidence, manual massage methods include the following aspects: before the patients recoveried from the anesthesia, let their family help

11、the nursing staff to turn over the patientsbody once every two hours, therby improving the compression of the limb blood circulation; Give passive movement to the lower limb of the patients, the tautness of the muscle of the limb activity, benefit venous blood. After the patients recoveried from ane

12、sthesia, encourage patients have deep breath after a sober,12-15 times per hour in order to increase the transverse septum exercise, reducing the pleural pressure, promote blood circulation; Encourage the patients to do autonomy lower limb exercise. Encourage the patients take the initiative planter

13、 flexion and extention of the lower limbs include inverted movement, ankleswitah movement. For the elderly patients, guide the family members to help nurses to do passive bottom-up massage of lower limb soleus and gastrocnemius. Pay attention to keeping warm after operation, so that the vein not spa

14、sm. Encorage the patients to get out of bed early and do exercises. The patients can sit on the bed 24 hours after hysterectomy and do activity to both lower extremities. The patients can get out of bed 48 hours after operation, but tell them move slowly and gradually.The ways of Intermittent pneuma

15、tic compression systems when patients go back to wards after hysterectomy, they use the intermittent pneumatic compression system for preventive teatment. Then the frequency is 2 times one day , one time is for 2 hours. Both Lower limbs use that systerm at the same time for 2 days. The IPCS used in

16、experiment, Itsmanufacture is: Tyco Medical Equipment International trading(Shanghai)Co.Ltd, product name is KENDALL Series SCD stress antithrombotic pump, Product Specification Model is SCD EXPRESS tress system includes three components: mainframe, independent connection tubes, disposable sets of l

17、egs. Legs sets models include straight, gradient, circumferential stress mode,45mmHg to ankle,40mmHg to the calf,30mmHg to the thigh.SCD EXPRESS intermittent pneumatic compress devices of the intravenous. It can develop the operating parameters for each individual patient. The system detect the filling time of venous every 30 minutes and ajust the treatment parameters.Results:1. 128 c