周期性充氣加壓預(yù)防子宮切除術(shù)后下肢深靜脈血栓的研究

1、周期性充氣加壓預(yù)防子宮切除術(shù)后下肢深靜脈血栓的研究        【中文摘要】下肢深靜脈血栓(deep venous thrombosis,DVT)是外科手術(shù)常見(jiàn)的并發(fā)癥之一。在外科不同種類手術(shù)后DVT的患者中,婦產(chǎn)科患者占14%-19%。子宮切除術(shù)是婦科最常見(jiàn)的手術(shù)之一,下肢深靜脈血栓是該手術(shù)后非常危險(xiǎn)的并發(fā)癥。通過(guò)查閱國(guó)內(nèi)外文獻(xiàn)所做的大樣本調(diào)查發(fā)現(xiàn)婦科惡性腫瘤術(shù)后下肢深靜脈血栓的發(fā)生率明顯高于良性腫瘤患者。目前手術(shù)后下肢深靜脈血栓的預(yù)防由于缺乏確切的臨床證據(jù)而沒(méi)有同一的治療標(biāo)準(zhǔn),因此探討有效的預(yù)防子宮切除術(shù)后下

2、肢深靜脈血栓的方法是很有必要的。下肢深靜脈血栓治療比較復(fù)雜,患者隨時(shí)都有危險(xiǎn)存在,并且治療時(shí)間也較長(zhǎng),因此圍手術(shù)期的預(yù)防尤為重要。當(dāng)前觀點(diǎn)以為應(yīng)用化學(xué)性方法如小劑量應(yīng)用低分子肝素來(lái)預(yù)防DVT的效果是肯定的,但預(yù)防的同時(shí)也存在出血、血腫等并發(fā)癥的危險(xiǎn)。因此無(wú)創(chuàng)型的物理預(yù)防方法逐漸備受關(guān)注。但目前能夠確切說(shuō)明物理性預(yù)防措施在子宮切除術(shù)后DVT形成中的效果及臨床應(yīng)用遠(yuǎn)景的資料很少。為了更好地預(yù)防子宮切除術(shù)后下肢深靜脈血栓的發(fā)生,本研究旨在尋求更加公道有效的預(yù)防下肢深靜脈血栓的物理方法。將使用周期性充氣加壓系統(tǒng)的患者作為實(shí)驗(yàn)組,未使用周期性充氣加壓系統(tǒng)的患者作為對(duì)照組,用秩和檢驗(yàn)比較實(shí)驗(yàn)組和對(duì)照組患者

3、DVT發(fā)生情況的差異。');【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