PCEA下运动对骨科患者术后深静脉血栓形成的影响.docVIP

PCEA下运动对骨科患者术后深静脉血栓形成的影响 张成明 张培梅 陈淑琴 （潍坊医学院附属医院 山东 潍坊261031） 摘要 目的 探讨PCEA止痛对下骨科患者术后深静脉血栓形成的影响。方法：硬膜外麻醉下骨科非创伤下肢手术40例，随机均分为实验组术后PCEA，药物0.15%布比卡因+0.004%吗啡+0.002%氟哌利多混合液2ml/h，对照组不进行术后止痛。监测术后1-6天股静脉血流量、手术后疼痛VAS评分及出凝血功能。结果 术后1-6天实验组股静脉血流量较对照组显著大(P0.0l )，术后2-4天实验组患肢疼痛程度显著低于对照组（P 0.0l），术后第6天实验组血浆D-二聚体水平显著低于对照组(p0.05)，术前及术后6天两组Fg、PT、PT-%、APTT、PT-INR均无显著性差异(P 0.05)。结论 PCEA止痛后下肢运动幅度加大有利于防治深静脉血栓形成。 关键词 深静脉血栓形成（DVT） 硬膜外病人自控性镇痛（PCEA） 股静脉血流量（BF） VAS 视觉模拟评分 D-二聚体(D-D) 中图分类法 R473.6 文献标识码A The Effects of Nursing on Deep Venous Thrombosis under Patient Controlled Epidural Analgesia in Orthopedics Zhang Chengming etal. (Department of Orthopedics, Affiliated Hospital to Weifang Medical College, Weifang,261031,China) [Abstract] Objective To evaluate the effects of nursing on deep venous thrombosis under Patient Controlled Epidural Analgesia in orthopedics.Methods 40 cases were randomed and divided equipartition into two groups : experiment group (with PCEA at 2ml/h of 0.15% bupivacaine,0.004% morphine and 0.002% Droperidol )and control group (without PCEA). monitoring blood flow in femoral vein,VAS and blood clotting in postop 1-6 day. Results Blood flow in femoral vein in experiment group showed more than control group level in postop 1-6 days (P0.0l ),VAS in experiment group showed lower than control group in postop 2-4 days (P0.0l ), D-D in experiment group is significant lower control group (p0.05) and Fg,PT,PT-%,APTT, PT-INR are no significant(P 0.05) the 6th day after postop. Conclnsion The nursing under Patient Controlled Epidural Analgesia in orthopedics can reduce deep venous thrombosis. Key words deep venous thrombosis（DVT） Patient Controlled Epidural Analgesia （PCEA） femoral vein blood flow VAS D-dimer PCEA下运动对骨科患者术后深静脉血栓形成的影响 深静脉血栓形成(Deep Venous Thrombosis, DVT) 是骨科术后常见并发症之一，可造成致死性肺栓塞、截肢及下肢深静脉血栓后综合征等严重后果，逐渐受到关注，对于DVT预防措施的研究也开始广泛开展[1-3]。本文通过PCA止痛及止痛下护理工作对骨科手术患者深静脉血栓形成的干预进行对比研究，现报告如下： 1一般资料 1.1病例选择 骨科非创伤下肢手术40例，其中男性28例，女性12例，年龄46-72岁，平均63.8岁，血常规