人工膝关节置换术后药物抗凝空窗期使用间歇充气加压装置的安全性及成本效果分析

杨昌凤; 何永琴; 周媛媛; 黄盈; 赖淋雨; 张玉梅

doi:10.16016/j.2097-0927.202209271

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人工膝关节置换术后药物抗凝空窗期使用间歇充气加压装置的安全性及成本效果分析

临床医学 | 更新时间：2026-01-09

- 人工膝关节置换术后药物抗凝空窗期使用间歇充气加压装置的安全性及成本效果分析
- Safety and cost-effectiveness analysis of using intermittent inflation and compression device during drug anticoagulation window period after artificial knee arthroplasty
- 陆军军医大学学报 2023年45卷第5期页码：450-455
- 作者机构：
  
  1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院骨科
  2.400037 重庆，陆军军医大学(第三军医大学)第二附属医院超声科
- 作者简介：
  
  [张玉梅，E-mail：zhangyumei19693@sina.comZHANG Yumei, E-mail: zhangyumei19693@sina.com
- 基金信息：
  
  陆军军医大学第二附属医院临床科研项目(2018YLC09)
- DOI：10.16016/j.2097-0927.202209271
  中图分类号： R197.38;R473.6;R687.4
- 收稿：2022-09-28，
  
  修回：2022-11-28，
  
  纸质出版：2023-03-15
- 稿件说明：
移动端阅览
杨昌凤, 何永琴, 周媛媛, 等. 人工膝关节置换术后药物抗凝空窗期使用间歇充气加压装置的安全性及成本效果分析[J]. 陆军军医大学学报, 2023,45(5):450-455.

Changfeng YANG, Yongqin HE, Yuanyuan ZHOU, et al. Safety and cost-effectiveness analysis of using intermittent inflation and compression device during drug anticoagulation window period after artificial knee arthroplasty[J]. Journal of Army Medical University, 2023, 45(5): 450-455.
杨昌凤, 何永琴, 周媛媛, 等. 人工膝关节置换术后药物抗凝空窗期使用间歇充气加压装置的安全性及成本效果分析[J]. 陆军军医大学学报, 2023,45(5):450-455. DOI： 10.16016/j.2097-0927.202209271.

Changfeng YANG, Yongqin HE, Yuanyuan ZHOU, et al. Safety and cost-effectiveness analysis of using intermittent inflation and compression device during drug anticoagulation window period after artificial knee arthroplasty[J]. Journal of Army Medical University, 2023, 45(5): 450-455. DOI： 10.16016/j.2097-0927.202209271.

摘要

目的

分析人工膝关节置换术(total knee arthroplasty

TKA)后药物抗凝空窗期使用间歇充气加压装置(intermittent pneumatic compression

IPC)的安全性及成本-效果。

方法

纳入行TKA手术的患者337例，采用随机数字表法进行分组，其中试验组168例，对照组169例。试验组在药物抗凝空窗期间双下肢持续使用IPC，对照组术后即刻至下床期间双下肢持续使用IPC，比较两组患者术后1 d肌间静脉丛血栓(muscular calf vein thrombosis

MCVT)的预防有效率、D2聚体水平、术后总失血量及成本-效果比的差异。

结果

2组患者术后1 d MCVT预防有效率、血红蛋白水平、总失血量、D2聚体水平比较，差异均无统计学意义；试验组IPC使用时间[6.00(6.00

6.00)h

]

较对照组[20.00(15.00

24.25)h

]

短，两组比较差异有统计学意义(

＜0.01)；试验组IPC使用总成本为172.84(172.84

172.84)元，与对照组[628.37(461.82

758.49)元

]

比较差异具有统计学意义(

0.01)；试验组的成本-效果比(2.23)小于对照组(7.75)。

结论

TKA术后药物抗凝空窗期使用IPC安全性好，较术后持续使用IPC具有更佳的成本效果。

Abstract

Objective

To analyze the safety and cost-effectiveness of intermittent pneumatic compression (IPC) during the intermittent pneumatic interval after total knee arthroplasty (TKA).

Methods

A total of 337 patients who underwent TKA surgery were included and randomly divided into experimental group (

=168) and control group (

=169). The experimental group continued to use IPC for both lower limbs during the anticoagulant window period

while the control group continued to use IPC for both lower limbs immediately after surgery to the time of getting out of bed. Muscular calf vein thrombosis (MCVT) prevention rate

D2 polymer level

total postoperative blood loss

and cost-effectiveness ratio were compared between the 2 groups in 1 d after surgery.

Results

There were no statistical significances in MCVT prevention effective rate

hemoglobin level

total blood loss

and D2 polymer level between the 2 groups in 1 d after surgery. The IPC time was 6.00 (6.00

6.00) h in the experimental group

significantly shorter than that in the control group [20.00 (15.00

24.25) h

0.01

]

. The total cost of IPC was significantly lower in the experimental group than the control group [172.84 (172.84

172.84)

628.37 (461.82

758.49) Yuan

0.01

]

. The cost-effectiveness ratio of the experimental group (2.23) was lower tha

n that of the control group (7.75).

Conclusion

The use of IPC during the anticoagulant window after TKA has good safety and better cost-effectiveness than the continuous use of IPC after surgery.

关键词

Keywords

references

ZENG C, BENNELL K, YANG Z D, et al . Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study[J ] . Ann Rheum Dis, 2020, 79(12): 1616-1624. DOI: 10.1136/annrheumdis-2020-217782.

邹林汝, 谭开彬, 高云华, 等. 静脉瘀滞指数对关节置换术后下肢深静脉血栓风险的评估[J]. 中国超声医学杂志, 2015, 31(11): 1032-1034.

ZOU L R, TAN K B, GAO Y H, et al . Using stasis index of vein to assess the risk of deep vein thrombosis after total knee or hip replacement[J ] . Chin J Ultrasound Med, 2015, 31(11): 1032-1034.

MACDONALD P S, KAHN S R, MILLER N, et al . Short-term natural history of isolated gastrocnemius and soleal vein thrombosis[J ] . J Vasc Surg, 2003, 37(3): 523-527. DOI: 10.1067/mva.2003.149.

GILLET J L, PERRIN M R, ALLAERT F A. Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis[J]. J Vasc Surg, 2007, 46(3): 513-519. DOI: 10.1016/j.jvs.2007.04.040.

BOSQUE J R, COLEMAN S I, DI CESARE P. Relationship between deep vein thrombosis and pulmonary embolism following tha and TKA[J]. Orthopedics, 2012, 35(3): 228-233;quiz 234-235. DOI: 10.3928/01477447-20120222-12.

KRET M R, LIEM T K, MITCHELL E L, et al . Isolated calf muscular vein thrombosis is associated with pulmonary embolism and a high incidence of additional ipsilateral and contralateral deep venous thrombosis[J ] . J Vasc Surg Venous Lymphatic Disord, 2013, 1(1): 33-38. DOI: 10.1016/j.jvsv.2012.04.001.

LAUTZ T B, ABBAS F, WALSH S J, et al . Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation?[J ] . Ann Surg, 2010, 251(4): 735-742. DOI: 10.1097/SLA.0b013e3181c1ae95.

AMARASE C, TANAVALEE A, LARBPAIBOONPONG V, et al . Asia-pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: part 2. mechanical venous thromboembolism prophylaxis[J ] . Knee Surg Relat Res, 2021, 33(1): 20. DOI: 10.1186/s43019-021-00101-7.

NGARMUKOS S, KIM K I, WONGSAK S, et al . Asia-pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: part 1. diagnosis and risk factors[J ] . Knee Surg Relat Res, 2021, 33(1): 18. DOI: 10.1186/s43019-021-00099-y.

KEARON C, AKL E A, ORNELAS J, et al . Antithrombotic therapy for vte disease: chest guideline and expert panel report[J ] . Chest, 2016, 149(2): 315-352. DOI: 10.1016/j.chest.2015.11.026.

中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华骨科杂志, 2016(2): 65-71. DOI: 10.3760/cma.j.issn.0253-2352.2016.02.001.

Orthopedic Branch of Chinese Medical Association. Prevention guide of venous thromboembolism in major orthopedic surgery in China[J]. Chin J Orthop, 2016(2): 65-71. DOI:10.3760/cma.j.issn.0253-2352.2016.02.001.

PAVON J M, ADAM S S, RAZOUKI Z A, et al . Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical patients: a systematic review[J ] . J Arthroplasty, 2016, 31(2): 524-532. DOI: 10.1016/j.arth.2015.09.043.

《中国血栓性疾病防治指南》专家委员会. 中国血栓性疾病防治指南[J]. 中华医学杂志, 2018, 98(36): 2861-2888.

Expert Committee of Chinese Guidelines for Prevention and Treatment of Thrombotic Diseases . Chinese guidelines for prevention and treatment of thrombotic diseases[J ] . Natl Med J China, 2018, 98(36): 2861-2888.

ZHANG Z, LEI J P, SHAO X, et al . Trends in hospitalization and in-hospital mortality from vte, 2007 to 2016, in China[J ] . Chest, 2019, 155(2): 342-353. DOI: 10.1016/j.chest.2018.10.040.

NICOLAIDES A, GOLDHABER S Z, MAXWELL G L, et al . Cost benefit of intermittent pneumatic compression for venous thromboembolism prophylaxis in general surgery[J ] . Int Angiol, 2008, 27(6): 500-506.

SAUNDERS R, COMEROTA A J, OZOLS A, et al . Intermittent pneumatic compression is a cost-effective method of orthopedic postsurgical venous thromboembolismprophylaxis[J ] . Clinicoecon Outcomes Res, 2018, 10: 231-241. DOI:10.2147/CEOR.S157306.

NIEMI T T, PITKÄNEN M, SYRJÄLÄ M, et al . Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty[J ] . Acta Anaesthesiol Scand, 2000, 44(4): 457-464. DOI: 10.1034/j.1399-6576.2000.440418.x.

CHENG K, GIEBALY D, CAMPBELL A, et al . Systemic effects of polymethylmethycrylate in total knee replacement: a prospective case-control study[J ] . Bone Joint Res, 2014, 3(4): 108-116. DOI: 10.1302/2046-3758.34.2000230.

TYAGI V, TOMASZEWSKI P, LUKASIEWICZ A, et al . The role of intraoperative intermittent pneumatic compression devices in venous thromboembolism prophylaxis in total hip and total knee arthroplasty[J ] . Orthopedics, 2018, 41(1): e98-e103. DOI: 10.3928/01477447-20171114-06.

刘旭, 姚尧, 戎朕, 等. 全膝关节置换术后下肢深静脉血栓发生的时间分布[J]. 中国矫形外科杂志, 2015, 23(11): 991-995. DOI: 10.3977/j.issn.1005-8478.2015.11.07.

LIU X, YAO Y, RONG Z, et al . Time course of lower extremity deep venous thrombosis after total knee arthroplasty[J ] . Orthop J China, 2015, 23(11): 991-995. DOI: 10.3977/j.issn.1005-8478.2015.11.07.

NAKANISHI K, TAKAHIRA N, SAKAMOTO M, et al . Effects of intermittent pneumatic compression of the thigh on blood flow velocity in the femoral and popliteal veins: developing a new physical prophylaxis for deep vein thrombosis in patients with plaster-cast immobilization of the leg[J ] . J Thromb Thrombolysis, 2016, 42(4): 579-584. DOI: 10.1007/s11239-016-1403-y.

HE X, ZHAO M, BI X Y, et al . Delayed preconditioning prevents ischemia/reperfusion-induced endothelial injury in rats: role of ros and enos[J ] . Lab Invest, 2013, 93(2): 168-180. DOI: 10.1038/labinvest.2012.160.

OBI A T, ALVAREZ R, REAMES B N, et al . A prospective evaluation of standard versus battery-powered sequential compression devices in postsurgical patients[J ] . Am J Surg, 2015, 209(4): 675-681. DOI:10.1016/j.amjsurg.2014.06.017.

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