标题：梯度压力弹力袜联合足底动静脉泵干预对乳房重建术后下肢静脉栓塞的预防研究

      作者：李娅岐，赵亚楠，常琼娟    郑州大学第一附属医院乳腺外二科，河南 郑州 450000

      卷次： 2024年35卷3期

      【摘要】 目的 探讨梯度压力弹力袜联合足底动静脉泵干预对乳房重建术后下肢静脉栓塞的预防效果。方法 选择2018年1月至2022年3月郑州大学第一附属医院收治的90例乳房重建术患者作为研究对象，根据随机数表法将患者分为对照组和观察组各45例。对照组患者采用足底动静脉泵干预，观察组患者在对照组干预的基础上联合梯度压力弹力袜干预，两组患者均连续干预两周。比较两组患者干预前及干预结束后的大腿和小腿的根部周径、下肢静脉峰值流速、胫后静脉平均流速、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]水平，并记录干预期间下肢静脉栓塞及下肢水肿的发生率。结果 干预前，两组患者的大腿和小腿的根部周径、下肢静脉峰值流速、胫后静脉平均流速、凝血功能指标比较差异均无统计学意义(P>0.05)；干预结束后，观察组患者的大腿、小腿根部周径分别为(58.37±3.06) cm、(38.70±4.14) cm，明显小于对照组的(60.12±4.92) cm、(41.28±5.39) cm，下肢静脉峰值流速、胫后静脉平均流速分别为(17.80±3.13) cm/s、(8.55±1.84) cm/s，明显快于对照组的(15.65±3.04) cm/s、(7.01±1.49) cm/s，APTT、TT、PT、FIB分别为(30.28±3.37) s、(14.59±2.04) s、(11.59±1.85) s、(2.83±0.21) mg/L，明显低于对照组的(32.51±3.66) s、(16.87±2.13) s、(12.03±1.67) s、(3.54±0.40) mg/L，差异均有统计学意义(P<0.05)；干预期间，观察组患者的下肢静脉栓塞、下肢水肿的发生率分别为4.44%、6.67%，明显低于对照组的17.78%、22.22%，差异均有统计学意义(P<0.05)。结论 乳房重建术后采用梯度压力弹力袜联合足底动静脉泵干预，能改善患者的下肢周径、下肢静脉流速和凝血功能，降低下肢静脉栓塞和水肿的发生率，值得临床推广应用。
      【关键词】 乳房重建术；下肢静脉栓塞；梯度压力弹力袜；足底动静脉泵；凝血功能
      【中图分类号】 R713 【文献标识码】 A 【文章编号】 1003—6350（2024）03—0425—04

Study on the prevention of lower extremity venous embolism after breast reconstruction by graduatedcompression stockings combined with plantar arteriovenous pump intervention.
LI Ya-qi, ZHAO Ya-nan, CHANGQiong-juan. The Second Department of Breast Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou450000, Henan, CHINA
【Abstract】 Objective To investigate the prevention of lower extremity venous embolism after breast recon-struction by graduated compression stockings combined with plantar arteriovenous pump intervention. Methods Nine-ty patients who underwent breast reconstruction surgery at the First Affiliated Hospital of Zhengzhou University fromJanuary 2018 to March 2022 were selected as the research objects. According to the random number table method, thepatients were divided into a control group and an observation group, with 45 cases in each group. The patients in the con-trol group were treated with plantar arteriovenous pump intervention, and the patients in the observation group were treat-ed with graduated compression stockings on the basis of the intervention of the control group, continuously for 2 weeks.The root circumference of the thighs and calves, peak flow velocity of lower limb veins, average flow velocity of posteri-or tibial veins, and coagulation function indicators [(activated partial thromboplastin time (APTT), thrombin time (TT),prothrombin time (PT), fibrinogen (FIB)] levels before and after intervention were compared between the two groups.The incidence of lower limb venous embolism and edema during the intervention period was recorded. Results Beforethe intervention, there was no statistically significant difference in the root circumference of the thighs and calves, peakvenous flow velocity of the lower limbs, average venous flow velocity of the posterior tibia, and coagulation function in-dicators between the two groups (P>0.05). After the intervention, the root circumference of the thighs and calves in theobservation group were (58.37 ± 3.06) cm and (38.70 ± 4.14) cm, respectively, which were significantly smaller than(60.12±4.92) cm and (41.28±5.39) cm in the control group; the peak flow velocity of the lower limb vein and the aver-age flow velocity of the posterior tibial vein were (17.80±3.13) cm/s and (8.55±1.84) cm/s, respectively, significantlyfaster than (15.65±3.04) cm/s and (7.01±1.49) cm/s in the control group; the APTT, TT, PT, FIB values were (30.28±3.37) s, (14.59±2.04) s, (11.59±1.85) s, and (2.83±0.21) mg/L, respectively, significantly lower than (32.51±3.66) s,(16.87±2.13) s, (12.03±1.67) s, and (3.54±0.40) mg/L in the control group (P<0.05). During the intervention period, theincidence rates of lower limb venous embolism and lower limb edema in the observation group were 4.44% and 6.67%,respectively, which were significantly lower than 17.78% and 22.22% in the control group (P<0.05). Conclusion Afterbreast reconstruction, graduated compression stockings combined with plantar artervenous pump intervention can im-prove lower limb diameter, lower limb venous flow rate and coagulation function, and reduce the incidence of lowerlimb venous embolism and edema, which is worthy of clinical application.
      【Key words】 Breast reconstruction; Lower extremity venous embolism; Graduated compression stockings; Plan-tar arteriovenous pump; Coagulation function