多种方法预防ICU长期住院患者下肢深静脉血栓形成的效果评价

摘要

目的：比较药物（低分子量肝素钠）、气压仪干预及肢体锻炼联合穴位按摩3种方法预防ICU长期住院患者下肢深静脉血栓形成（ DVT）的效果。方法选取2014年6月—2015年10月温州医科大学附属第二医院ICU长期住院的符合纳入标准的患者90例。按照随机数字表法分为肝素组、气压仪干预组和锻炼联合按摩组，每组30例。肝素组患者给予低分子量肝素钠注射液进行干预，气压仪干预组患者给予双下肢气压干预，锻炼联合按摩组患者给予肢体锻炼联合穴位按摩法进行干预，均连续干预21 d。比较3组患者治疗第1、7、21天全血黏度高切水平、全血黏度低切水平、D―二聚体水平、凝血酶原时间（ PT）、部分活化凝血活酶时间（ APTT）以及股深静脉、腘静脉、胫后静脉血流速度，并统计3组患者干预第1、7、21天DVT发生率。结果干预方法与时间在全血黏度高切、全血黏度低切水平上存在交互作用（p〈0.05）；干预方法和时间在全血黏度高切、全血黏度低切水平上主效应显著（p〈0.05）；3组患者干预第21天全血黏度高切、全血黏度低切水平均低于干预第1天（ p〈0.05）；干预第21天气压仪干预组和锻炼联合按摩组患者全血黏度高切、全血黏度低切水平均高于肝素组（ p〈0.05）。干预方法与时间在D―二聚体水平上存在交互作用（p〈0.05）；干预方法和时间在D―二聚体水平上主效应显著（p〈0.05）；3组患者干预第1、7、21天D―二聚体水平比较，差异无统计学意义（ p〉0.05）。干预方法与时间在PT、APTT上存在交互作用（ p〈0.05）；干预方法和时间在 PT、APTT 上主效应显著（ p 〈0.05）；3组患者干预第21天 PT、APTT 均短于干预第1天（ p 〈0.05）；干预第21天气压仪干预组和锻炼联合按摩组患者PT、APTT均长于肝素组（ p〈0.05）。干预方法与时间在股深静脉、腘静脉、胫后静脉血流速度上存在交互作用（ p〈0.05）；干预方法和时间在股深静脉、腘静脉、胫后静脉血流速度上主效应显著（p〈0.05）；3组患者干预第21天股深静脉、腘静脉、胫后静脉血流速度均快于干预第1天（p〈0.05）；干预第21天气压仪干预组和锻炼联合按摩组患者股深静脉、腘静脉、胫后静脉血流速度均慢于肝素组（ p〈0.05）。干预第1天3组患者均未发生DVT；干预第7天，肝素组患者未发生DVT，气压仪干预组、锻炼联合按摩组患者DVT发生率分别为3.3﹪（1/30）、3.3﹪（1/30）；干预第21天，肝素组、气压仪干预组、锻炼联合按摩组患者DVT发生率分别为3.3﹪（1/30）、16.7﹪（5/30）、13.3﹪（4/30）。结论药物、气压仪干预及肢体锻炼联合穴位按摩均对DVT有一定预防作用，其中低分子量肝素预防DVT的效果最佳。%Objective To compare the effects of drugs ( low molecular weight heparin sodium ), air pressure intervention and physical exercise combined with acupuncture point massage on preventing deep vein thrombosis( DVT)of long―term hospitalized patients in ICU. Methods According to the inclusion standard,ninety long―term hospitalized patients in ICU of the Second Affiliated Hospital of Wenzhou Medical University from June 2014 to October 2015 were selected. The subjects were randomly divided into the following three groups:heparin group,air pressure intervention group,and exercise combined with massage group. Each group had 30 patients. The heparin group received low molecular weight heparin sodium injection. The air pressure intervention group received air pressure intervention of lower limbs,and exercise combined with massage group received physical exercise combined with acupuncture point massage. The intervention of the three groups lasted for 21 days. The level of high cut and low cut of whole blood viscosity,D ― dimer,prothrombin time( PT),activated partial thromboplastin time ( APTT),and blood flow velocity of deep femoral vein,popliteal vein and posterior tibial vein at the first,seventh and twenty―first day of the treatment among patients in the three groups were compared,and the incidence of DVT of patients intervened at the first,seventh and twenty―first day was summarized. Results The intervention method and time had significant interactive effects on the high cut and low cut of whole blood viscosity(p〈0. 05);the intervention method and time had significantly main effect on the high cut and low cut of whole blood viscosity(p〈0. 05);the high cut and low cut of whole blood viscosity at the twenty―first day of intervention were lower than those at the first day of intervention among patients in the three groups ( p〈0. 05 );the high cut and low cut of whole blood viscosity at the twenty―first day of intervention in air pressure intervention group and exercise combined with massage group were higher than those in heparin group ( p〈0. 05 ). The intervention method and time had significant interactive effects and significantly main effect on the D―dimer level(p〈0. 05);there was no significant difference in the D―dimer level at the first,seventh and twenty―first day of intervention among the three groups(p〉0. 05). The intervention method and time had significant interactive effects and significantly main effect on PT and APTT ( p〈0. 05 );the PT and APTT at the twenty―first day of intervention were lower than those at the first day of intervention among patients in the three groups( p 〈0. 05 );the PT and APTT at the twenty ― first day of intervention in air pressure intervention group and exercise combined with massage group were longer than those in heparin group ( p〈0. 05 ). The intervention method and time had significant interactive effects and significantly main effect on blood flow velocity of deep femoral vein,popliteal vein and posterior tibial vein(p 〈0. 05);the blood flow velocity of deep femoral vein,popliteal vein and posterior tibial vein at the twenty―first day of intervention were faster than those at the first day of intervention among patients in the three groups ( p〈0. 05);the blood flow velocity of deep femoral vein, popliteal vein and posterior tibial vein at the twenty ― first day of intervention in air pressure intervention group and exercise combined with massage group were slower than those in heparin group (p〈0. 05). No DVT occurred in the three groups at the first day of the intervention;no DVT occurred in the heparin group at the seventh day of the intervention,and the incidence of DVT in the air pressure intervention group,and exercise combined with massage group was both 3. 3﹪(1/30). At the 21st day of the intervention,the incidence of DVT in heparin group,air pressure intervention group,and exercise combined with massage group was 3. 3﹪(1/30),16. 7﹪(5/30),and 13. 3﹪(4/30)respectively. Conclusion Drugs,air pressure and physical exercise combined with acupuncture point massage have certain effects on the prevention of DVT,and the effect of low molecular weight heparin is the best.