目的:深静脉血栓(DVT)在腹腔镜手术后的截石位常见。间歇性气动压缩(IPC)在预防DVT中起着重要作用。然而,很少有研究比较了IPC应用的不同压缩领域。假设压缩套筒的位置可能对血栓预防的效果有影响。
方法:在本随机分组中,从2020年8月至2021年3月进行的对照试验,计划接受腹腔镜Dixon手术的164例患者被随机分配到四组之一,根据手术期间压缩套筒的双侧放置:脚,小牛,大腿,或控制(无IPC)。手术后第1天和第7天监测下肢DVT,使用超声评估平均血流速度,血流量,和共同股静脉的直径。进行血栓形成相关血液学分析。
结果:手术后第1天,与对照组相比,脚或小腿的IPC与DVT患病率降低相关(两者:P=0.024;OR=0.09;95%CI,0.01-0.72),而大腿IPC无显著获益(P=0.781;OR=0.86;95%CI,0.29-2.55)。与对照组相比,脚和小腿的IPC在左肢的DVT患病率较低(两者,P=0.048)。与对照组相比,左脚和右脚(分别为P=0.006和0.007)和小腿(分别为P=0.011和P=0.026)的IPC手术后,股总静脉的平均血流速度显着增加。同样,随着脚和小腿的IPC,左股总静脉的血流量更大(分别为P=0.03和0.027)。然而,手术后第7天,DVT的发生率和血栓形成的血液学指标的组间差异不显著.
结论:手术后第1天,IPC应用于脚或小腿促进静脉回流,因此,降低DVT的患病率,尤其是左肢.然而,术后第7天,四组患者DVT或血栓相关血液学指标的发生率无显著差异.中国临床试验注册标识符:ChiCTR2000035325。
Deep vein thrombosis (DVT) is common in the lithotomy position after laparoscopic surgery. Intermittent pneumatic compression (IPC) plays an important role in DVT prevention. However, few studies have compared the different compression areas of IPC application. It was hypothesized that the location of the compression sleeves could have an impact on the effects of thromboprophylaxis.
In this randomized, controlled
trial performed from August 2020 to March 2021, 164 patients scheduled to undergo laparoscopic Dixon surgery were randomly assigned to one of four groups, based on the bilateral placement of compression sleeves during surgery: feet, calves, thighs, or control (no IPC). Both lower extremities were monitored for DVT on days 1 and 7 after surgery, using ultrasonographic assessment of mean blood velocity, blood flow volume, and diameter of the common femoral veins. Thrombosis-related hematologic analysis was performed.
On day 1 after surgery, IPC of the feet or calves was associated with a reduced prevalence of DVT compared with controls (both: P = 0.024; OR = 0.09; 95% CI, 0.01-0.72), while IPC of the thighs had no significant benefit (P = 0.781; OR = 0.86; 95% CI, 0.29-2.55). The prevalence of DVT in the left extremity was lower with IPC of the feet and calves compared with controls (both, P = 0.048). The mean blood velocity in the common femoral vein was significantly increased after surgery with IPC of the left and right feet (P = 0.006 and 0.007, respectively) and calves (P = 0.011 and P = 0.026, respectively) compared with controls. Similarly, the volume of blood flow in the left common femoral vein was greater with IPC of the feet and calves (P = 0.03 and 0.027, respectively). However, on day 7 after surgery, the between-group differences in the prevalences of DVT and hematologic indicators of thrombosis were not significant.
On day 1 after surgery, IPC application at the feet or calves facilitated venous return and, hence, reduced the prevalence of DVT, especially in the left extremities. However, there were no significant differences in the prevalences of DVT or thrombosis-related hematologic indicators among the four groups on the day 7 after surgery. Chinese Clinical
Trial Registration identifier: ChiCTR2000035325.