From private practice.
Plast Reconstr Surg. 2020 Feb;145(2):392-401. doi: 10.1097/PRS.0000000000006464.
Sequential compression devices are often considered a mainstay of prophylaxis against deep venous thromboses in surgical patients. The devices are believed to produce a milking action on the deep veins to prevent venous stasis. A systemic fibrinolytic effect has also been proposed, adding a second mechanism of action. The plasma levels of tissue plasminogen activator and plasminogen activator inhibitor-1 reflect fibrinolytic activity.
A randomized trial was conducted among 50 consecutive plastic surgery outpatients undergoing cosmetic surgery performed by the author under total intravenous anesthesia and without paralysis. Patients were randomized to receive calf-length sequential compression devices or no sequential compression devices during surgery. Blood samples were obtained from the upper extremity preoperatively and at hourly intervals until the patient was discharged from the postanesthesia care unit. Tissue plasminogen activator and plasminogen activator inhibitor-1 levels were measured. Ultrasound surveillance was used in all patients. There was no outside funding for the study.
All patients agreed to participate (inclusion rate, 100 percent). No patient developed clinical signs or ultrasound evidence of a deep venous thrombosis. There were no significant changes in tissue plasminogen activator levels or plasminogen activator inhibitor-1 levels from the preoperative measurements at any hourly interval and no differences in levels comparing patients treated with or without sequential compression devices.
No significant change in systemic fibrinolytic activity occurs during outpatient plastic surgery under total intravenous anesthesia. Sequential compression devices do not affect tissue plasminogen activator or plasminogen activator inhibitor-1 levels, suggesting no fibrinolytic benefit.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
连续压迫装置通常被认为是预防外科手术患者深静脉血栓形成的主要手段。这些设备被认为对深静脉产生挤压作用，以防止静脉淤滞。也提出了全身纤维蛋白溶解作用，增加了第二种作用机制。组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1 的血浆水平反映了纤维蛋白溶解活性。
作者对 50 例连续接受全身静脉麻醉且无麻痹的整形手术门诊患者进行了一项随机试验，这些患者均接受美容手术。患者被随机分配在手术期间使用或不使用小腿长度的连续压迫装置。在上肢术前和每小时采集血样，直到患者从麻醉后监护病房出院。测量组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1 水平。所有患者均进行超声监测。该研究没有外部资金支持。
所有患者均同意参与（参与率为 100%）。没有患者出现深静脉血栓形成的临床或超声证据。在任何一个小时的间隔内，组织型纤溶酶原激活物水平或纤溶酶原激活物抑制剂-1 水平均未从术前测量值发生显著变化，并且治疗组与未治疗组之间的水平也没有差异。
在全身静脉麻醉下进行门诊整形手术时，全身纤维蛋白溶解活性没有明显变化。连续压迫装置不会影响组织型纤溶酶原激活物或纤溶酶原激活物抑制剂-1 水平，这表明没有纤维蛋白溶解益处。
临床问题/证据水平：治疗，I 级。
