Giannoni M F, Ciatti R, Capoccia L, Ruggiero M, Dauri M, Mariani P P
Department of Vascular Surgery, La Sapienza University of Rome, Rome, Italy.
Int Angiol. 2006 Sep;25(3):316-21.
The aim of this study was to determine the role of combined mechanical and pharmacological prophylaxis in the prevention of deep venous thrombosis (DVT) after total knee replacement (TKR).
prospective case series study.
Between October 2002 and June 2003, 38 total knee procedures were carried out on 34 patients (4 patients had bilateral TKR). To exclude the presence of a concomitant DVT echo-color-flow of the legs was performed between 2 and 1 week prior to surgery, in the postoperative period (before discharging) and 30 days after surgery. Patients received one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight). An intermittent foot sole pump (IFSP) was applied in the recovery room postoperatively, in both feet for about 5 h a day and all night long, and continued at home until the 15(th) day.
No major perioperative or rehabilitation phase-related complications were observed (2 patients required manual drainage of blood clots from the wound). The incidence of DVT was 7.9% (3 cases). In one of these cases we observed a previous DVT so it was classified as rethrombosis. All were successfully treated with therapeutic introduced low molecular weight heparin (LMWH) therapy. No pulmonary embolism or deaths associated with the use of LMWH or IFSP were observed.
In our experience the combined prophylaxis with nadroparin calcium and IFSP significantly reduced the incidence of DVT.
本研究旨在确定机械与药物联合预防措施在全膝关节置换术（TKR）后预防深静脉血栓形成（DVT）中的作用。
前瞻性病例系列研究。
2002年10月至2003年6月期间，对34例患者实施了38例全膝关节置换手术（4例患者接受双侧TKR）。为排除合并DVT的存在，在手术前2至1周、术后（出院前）以及术后30天对患者双腿进行了超声彩色血流检查。患者每日皮下注射一次那屈肝素钙（剂量根据体重调整）。术后在恢复室应用间歇性足底泵（IFSP），双足均使用，每天约5小时，持续整晚，并在家中持续使用至第15天。
未观察到重大围手术期或康复阶段相关并发症（2例患者需要人工清除伤口内的血凝块）。DVT发生率为7.9%（3例）。其中1例患者之前存在DVT，因此被归类为再血栓形成。所有病例均通过引入治疗性低分子量肝素（LMWH）治疗成功治愈。未观察到与使用LMWH或IFSP相关的肺栓塞或死亡病例。
根据我们的经验，那屈肝素钙与IFSP联合预防措施显著降低了DVT的发生率。
