| With the description of the signs of deep venous thrombosis (DVT) by Ferriar in 1810, the recognition of DVT has begun. It has become more deeply on the recognition of DVT with the medical development. People have paid more attention to DVT for it would result in serious complications, such as fatal pulmonary embolism, amputation and the post-thrombotic syndrome and studies on the prophylaxis for DVT have been carried out. DVT is a well-known complication following surgical procedures, especially for orthopedic surgery, for example, total knee replacement (TKR) or total hip replacement (THR). It is one of the common reasons leading to high mortalities after surgery. Virchow's risk factors for DVT are injury to the intima, stasis of venous blood and blood hypercoagulability, which have been widely accepted since 1856. DVT prophylaxis aims at preventing blood stasis and changing blood hypercoagulability and nursing preventions emphasize on enhancing blood flow. In China, DVT preventions following THR just cover elevation of the legs and early mobilization. But they have little effects, especially for patients with high risk factors of DVT. Intermittent pneumatic compression (IPC) is used widespread abroad, but there are different opinions in their working mode to change blood stasis, and whether its mode is applicable for China remains investigation. This study first evaluates haemodynamic effect of the lower extremities with different interventions in healthy people, chooses a best IPC mode used in patients after THR, then assesses the effects on the patients with different nursing interventions, expecting to provide a new, effective nursing method to prevent DVT for bedridden patients after THR.Part 1 the Haemodynamic Effects of different Interventions on the deep vein of the lower extremities. 10 healthy volunteers with 20 lower extremities were selected and six different interventions including leg elevation, active dorsal to plantar flexion(ADPF), passive dorsal to plantar flexion(PDPF), mode IPC 45mmHg, mode IPC 55mmHg, mode IPC 65mmHg were given compared with supine resting. The haemodynamic parameters of the femoral vein including peak venous velocity,average venous velocity and unit time blood flow were measured under different interventions. Analyze the change of the haemodynamic parameters of the femoral vein and choose the best intervention and the best IPC mode to enhance blood flow.Results suggested: ? With the same intervention, there was no significant statistics difference between the haemodynamic effect of the right and the left femoral vein(P>0.05). (2) Compared with supine resting, the haemodynamic parameters of the femoral vein were all higher in other six interventions (p<0.01) .(3)ADPF, PDPF and mode IPC 45mmHg had the best efficacious haemodynamic effects, there were no significant differences among them(P>0.05). They all had higher haemodynamic parameters than other three interventions (p<0.01) . ?All of the three IPC modes accelerated venous velocity and enhanced blood flow, but mode IPC 45mmHg was the best one among them (p<0.01).Part 2 the Haemodynamic Effect on the vein of the lower extremities after THR with mode IPC 45mmHg Intervention. Patient to be performing THR were research subjects. They had color Doppler ultrasonography before THR and patients with DVT were excluded. 40 cases with successful THR were selected, who were randomly divided into control group and experimental group. The control group was given routine nursing after surgery, including ADPF, isometric contraction of quadriceps femoris; the experimental group was given IPC after surgery. The mode of IPC was: 45mmHg pressure, after 1-2 hours' compression, resting 10-20 minutes. It works continuously on the 1st day after THR, 7:00am to 9:00pm every day from the 2nd day. Evaluation measures: the haemodynamic parameters including peak venous velocity, average venous velocity and blood flow before surgery, immediately after operation and from 1th to 6th after surgery; the diameter of the lower extremities above and below knee a day before surgery, from 1th to 6th after surgery; the total drainage after surgery; detecting DVT with color Doppler ultrasonography on 7th day after surgery.Results suggested: ? There was no significantly difference in the haemodynamic parameters before and immediately after surgery between the control group and the experimental group(P>0.05). The haemodynamic parameters immediately after surgery had a significant decrease compared with that before surgery in both twogroups(p<0.01). (2) Everyday from 1st to 6th day after surgery, the haemodynamic parameters of the femoral vein in experimental group were higher than in control group(p<0.01). There was no significant difference in total drainage between two groups(p>0.05). (3) In control group, the haemodynamic parameters were still significantly lower on the 1st day after surgery than before surgery(p<0.01), then a little higher on the 2nd day. With the day off, the haemodynamic parameters gradually increased. There was a great increase in blood flow on 4th day. The lower extremities became significantly swelling after surgery compared with that before surgery(p<0.01). The swelling of the lower extremities continued until 5th day after THR(p>0.05). The results suggested that in the control group, the haemodynamic parameters decreased after surgery, the lower extremities became swelling, then with more activities, the blood flow enhanced gradually and the swelling decreased. (4) In experimental group, the haemodynamic parameters have significantly increased after THR(p<0.01) and there was no significant difference within the days after THR (p>0. 05). And the blood flow remained very fast. The lower extremity became a little swelling on 1th day(p0. 05). The results suggested IPC nursing can change stasis, decrease the swelling significantly and quickly. The swelling lessened and disappeared quickly. Conclusions:1. Compared with the supine resting, all of elevation of the leg, ADPF, PDPF, three and IPC mode can enhance blood flow effectively2. ADPF and PDPF causing gastrocnemius muscle contraction are normal physiologic mechanism that promotes venous return best.3. IPC compresses the lower extremities in sequence, which mimics the mechanism of DPF that enhances blood flow effectively. Mode IPC 45mmHg empties and engorges the vein enough, which is the best IPC mode to enhances blood flow.4. Venous blood became stasis after THR. In the control group, the haemodynamic parameters increased with the exercises increasing, but it couldn't achieve the effect of the healthy people made. The lower extremities became swelling after surgery because of blood stasis and the swelling disappeared on 5th day.
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