摘要
目的回顾比较206例下肢闭合骨折患者术前并发深静脉血栓（deepveinthrombosis，DVT）的不同临床处理的临床意义。方法回顾性分析1402例术前行患肢血管彩色多普勒血流显像（colordopplerflowimaging，CDFI）检查的下肢闭合骨折并发DVT206例患者的临床处理情况。根据患者和家属（以下简称“患方”）的意见分4组：I组13例，放弃手术保守治疗；Ⅱ组7例，溶栓治疗后手术，但3例溶栓失败；IU组6例，放置静脉滤网后手术；Ⅳ组180例，坚持术前不做处理要求手术治疗。结果①平均住院天数比较：I组〉II组〉Ⅲ组〉IV组，组间比较均P〈0．01。②Ⅱ组和Ⅲ组术中出血和术后渗血较多，均需输血治疗。③I组出现腰骶部褥疮、肺部和尿路感染并发症共4例，余3组则无。④麻醉实施情况，腰硬联合阻滞122例（63．2％），实施气管插管全麻71例（36．8％）。结论①下肢闭合骨折并发DVT患者坚持术前不做处理要求手术治疗，住院时间短、并发症少、患者满意度高，但麻醉手术工作者均面临着巨大的考验。②溶栓后和放置深静脉滤网后手术，术中出血和术后渗血均较多，术前应做好输血准备。③试探性分次给药单侧腰麻循环稳定、麻醉费用低、患者在麻醉恢复室停留时间短，有I临床应用价值。
Objective To analyze the clinical effects of different therapy process to the patients with deep vein thrombosis （DVT） during reduction and internal fixation surgery of lower extremity closed fracture through retrospective study of 206 cases. Methods Retrospective study of 1 402 patients with lower limb close fracture, 206 patients were found DVT by color doppler flow imaging（CDFI） in preoperative and were divided into four groups according to the choice of patients or their families. There were 13, 7, 6 and 180 patients in group I , II, llI, IV respectively. The patients in group I received expectant treatments. The patients in group II had chosen to have an operation after thrombolysis, but there were three patients failed. The patients in group III had an operation after the filter of deep venous placed. The patients in group IV had requested surgery without any other treatment. Results （1） There was significant difference in the average hospital stay among groups （group I 〉group Ⅲ 〉grouplU〉groupIV, P〈0.01 ）. （2） The surgical hemorrhage in group Ⅱ and group Ⅲ are more than that in group IV, and blood transfusion is needed. （3） There were four cases of complications such as lumbosacral region bedsore, urinary tract infection and pneumonia in group I. （4） There were 122 cases （63.2%） finished the operation under combined spinal epidural anesthesia （CSEA）, and 71 cases （36.8%） under tracheal intubation general anaesthesia （GA）. Conclusions （1） To operate for lower extremity closed fracture patients with deep vein thrombosis without preoperative treatment, there are more advantages such as shorter hospital stay, fewer complications and more satisfaction for the patients, but anesthesiologists will face more challenges because of more complicated clinical situations.（2） Theres more surgical hemorrhage because of preoperative thrombolysis treatment or placing filter of deep venous, and blood transfusion is needed. （3） Unilateral spinal anesthesia
出处
《国际麻醉学与复苏杂志》
CAS
2012年第8期530-532,542,共4页
International Journal of Anesthesiology and Resuscitation
关键词
下肢骨折
深静脉血栓
手术
麻醉
Lower extremity fracture
Deep vein thrombosis
Surgery
Anesthesia
