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目的观察并探讨早期主动+被动运动预防髋关节置换术后下肢深静脉血栓的临床效果。方法将2014年1月—2017年2月我院收治的122例髋关节置换患者按照随机数字分为干预组(62例)和对照组(60例),对照组患者术后予药物+物理抗凝预防下肢深静脉血栓(DVT),干预组在对照组基础上给予早期主动+被动运动干预,比较两组术前与术后3d、7d血流动力学指标、凝血指标、下肢周径变化,记录住院期间DVT发生率及发生部位。结果两组术后3d、7d股静脉血流峰速与平均血流速度均较本组术前升高,干预组术后指标高于对照组[3d:(42.3±5.6)cm~3 vs.(38.4±5.8)cm~3/s、(28.9±3.9)cm~3/s vs.(25.2±3.5)cm~3/s;7d:(49.7±6.9)cm~3/s vs.(44.3±6.2)cm~3/s、(34.2±3.8)cm~3/s vs.(30.4±3.6)cm~3/s](P<0.05)。两组术后3d、7d凝血酶原时间(PT)、凝血活酶时间(APTT)均较本组术前升高,干预组术后指标均高于对照组[3d:(14.0±2.1)s vs.(12.9±2.1)s、(34.1±4.7)s vs.(31.2±4.3)s;7d:(16.2±2.9)s vs.(15.1±2.5)s、(37.2±5.0)s vs.(34.8±4.6)s](P<0.05)。两组术后3d、7d髌上10cm、髌下10cm下肢周径均较本组术前升高,干预组术后3d、7d髌下10cm周径[3d:(37.0±3.9)cm vs.(38.7±3.4)cm;7d:(35.9±2.9)cm vs.(37.1±2.7)cm]及术后3d髌上10cm周径(47.1±3.8)cm vs.(48.4±3.4)cm均低于对照组水平(P<0.05)。两组均未出现肺动脉栓塞病例,干预组术后DVT发生率显著低于对照组(8.1%vs.21.7%)(P<0.05)。结论在药物+物理抗凝基础上,髋关节置换术后给予早期被动+主动运动能有效预防DVT的发生。
Objective To observe and discuss the clinical effect of early active + passive exercise in preventing lower extremity deep venous thrombosis after total hip arthroplasty. Methods From January 2014 to February 2017, 122 patients who underwent hip arthroplasty in our hospital were divided into intervention group (62 cases) and control group (60 cases) according to random numbers. Patients in control group were treated with drugs + physical resistance (DVT). The intervention group was given early active + passive exercise intervention on the basis of the control group. The hemodynamics, coagulation indexes, Record the incidence of DVT during hospitalization and the site of occurrence. Results The peak and average flow velocities of femoral vein at 3d and 7d postoperatively in both groups were significantly higher than those before surgery in the two groups. The postoperative indexes in the intervention group were higher than those in the control group [3d: (42.3 ± 5.6) cm ~ 3 vs. (38.4 ± 5.8) cm ~ 3 / s, (28.9 ± 3.9) cm ~ 3 / s vs. (25.2 ± 3.5) cm ~ 3 / s and 7d: (49.7 ± 6.9) cm ~ 3 / s vs. ± 6.2 cm 3 / s, 34.2 ± 3.8 cm 3 / s vs. 30.4 ± 3.6 cm 3 / s, respectively (P 0.05). Prothrombin time (PT) and thromboplastin time (APTT) on the 3rd and 7th day after operation were significantly higher in both groups than those in the control group [3d: (14.0 ± 2.1) s (12.9 ± 2.1) s, (34.1 ± 4.7) s vs. (31.2 ± 4.3) s, 7d: (16.2 ± 2.9) s vs. (15.1 ± 2.5) s, (37.2 ± 5.0) s vs. 34.8 ± 4.6) s] (P <0.05). The circumference of the lower limbs 10 cm above the patella and the lower 10 cm below the patellar at 3d and 7 d after operation were significantly higher than those before operation in the two groups (3d, 7d, 3d and 7d respectively) [3d: (37.0 ± 3.9) cm vs. 38.7 ± 3.4 cm; 7d: (35.9 ± 2.9) cm vs. (37.1 ± 2.7) cm], and the 10 cm circumference of the patella on the 3rd postoperative day were 47.1 ± 3.8 cm vs. 48.4 ± 3.4 cm Group level (P <0.05). No pulmonary embolism occurred in either group. The incidence of postoperative DVT in the intervention group was significantly lower than that in the control group (8.1% vs.21.7%, P <0.05). Conclusion On the basis of drug + physical anticoagulation, early passive + active exercise after hip replacement can effectively prevent DVT.