| Purpose: To acquire lower limb hemodynamic states of relatively healthy Chinese andold Chinese of different ages who will have selective operations with femoral neck orintertrochantoric fracture, evaluate the hemodynamic effect of the twothromboprophylactic products of Tyco Corporation of U.S. applied singly and thehemodynamic effect, the hemorheologic effect, protection of vascular wall andfibrinolytic state by combined applying both AES and IPC, further exploring themechanism of AES and IPC, establishing theoretical base for clinical application toChinese patients; try to change the design of the AES for increasing comfort,convenience, and compliance, exploring two suitable products for Chinese,decrease the incidence rate of DVT after operation.Methods: First, select 15 young healthy Chinese volunteers as the Young ControlGroup;15 old Chinese volunteers who can walk voluntarily without cardiovasculardiseases, cerebrovascular diseases, cancer, liver and kidney diseases or hemotologicdiseases as the Peer Control Group; 30 old orthopedic patients who will haveoperations randomly divided into two groups-Experimental Group and ExperimentalControl Group. Apply AES and IPC to experimental group together, and apply noneof them to experimental control group. Three hemodynamic indicators-diameter,maximum and average blood flow velocity of femoral vein should be measured forYouth Control Group by ultrasound before and after applying the two productsseparately, and blood reflux should also be measured (If there is blood reflux beforeapplying the two products, after applying, the reflux and stasis blood hidden behindthe venous valve should be monitored). Three hemodynamic indicators should bemeasured for Peer Control Group before and after combined applying of the twoproducts, and blood reflux should be measured; three hemodynamic indicators shouldbe measured for Experimental Control Group before operation and blood refluxshould be measured. Monitor them again during the 8th to the 14th day after operation.Draw blood to have fibrinogen, endothelins-1 and D-dimer three blood tests separately for the Experimental Control Group on the day before operation, and the 3day, the 7th day after operation. Comparison items: 1. Compare three hemodynamicindicators of Young Control Group, Peer Control Group and Experimental Groupbefore applying. 2. Compute the change of three hemodynamic indicators of YoungControl Group before and after applying of the two products separately. Compute thechange of three hemodynamic indicators of Young Control Group, Peer ControlGroup, and Experimental Group before and after combined applying. 3. Compare thedifference of change of three hemodynamic indicators between Young Control Group,Peer Control Group, and Experimental Group after combined applying. 4. Cut feetsection of AES and keep ankle and up section, then three hemodynamic indicators ismeasured after combined applying this cut AES and IPC, compare these indicatorswith uncutted AES and IPC. 5. Compute Young Control Group's hemodynamicchange. 6. Compare three blood test indicators of Experimental Group of differenttest date, Compare three blood test indicators of Experimental Control Group ofdifferent test date, and compare Experimental Group's three blood test indicators withExperimental Control Group's correspondingly. 7. For existence of blood reflux inYoung Control Group, Peer Control Group, and Experimental Group before applyingthe two products, the reflux and stasis blood hidden behind the venous valve shouldbe measured after both applying singly and combined applying AES and IPC.Results: 1. Compare three hemodynamic indicators of Young Control Group, PeerControl Group and Experimental Group before applying: no difference betweendiameters (P＞0.05), the maximum and average blood flow velocity of Young ControlGroup are faster than those of Peer Control Group and Experimental Group (P＜0.01),but there is no difference between Peer Control Group and Experimental Group(P＞0.05). 2. The diameter of Young Control Group decreased applying AES singly(P＜0.001), the maximum and average blood flow velocity increased (P＜0.001). Thediameter of Young Control Group didn't change after applying IPC singly (P＞0.05),the maximum and average blood flow velocity increased (P＜0.001). 3. Compare threehemodynamic indicators of Young Control Group, Peer Control Group andExperimental Group before and after combined applying both AES and IPC: nodifference between diameters (P＞0.05), the maximum and average blood flow velocity of Young Control Group and Peer Control Group are faster thanExperimental Group (P＜0.01), but there is no difference between Young ControlGroup and Peer Control Group (P＞0.05), that is, stop applying AES and IPC andmeasure after 30min, the diameter of femoral venous will not change, but themaximum and average blood flow velocity will decrease (P＜0.01). The averagedecrease of the diameter of the three groups is 18.2％, the average increase of themaximum blood flow velocity of Young Control Group and Peer Control Group is48.3％, the average increase of the average blood flow velocity of Young ControlGroup and Peer Control Group is 38.9 (keeping both AES and IPC), the averageincrease of the maximum blood flow velocity of Experimental Group is 22.9％, theaverage increase of the average blood flow velocity of Experimental Group is 38.9(stop applying AES and IPC and measure after 30min). 4. Cut feet section of AES andkeep ankle and up section and thus changing stockings to trousers, threehemodynamic indicators didn't change. That is, compared with uncutted AES, theeffect of cutted AES didn't decrease. 5. The average decrease of the diameter ofYoung Control Group is 19.20％after applying AES, the average increase of themaximum blood flow velocity is 18.09％, the average increase of the average bloodflow velocity is 20.69％, the diameter of Young Control Group didn't change afterapplying IPC singly, the average increase of the maximum blood flow velocity is22.22％, the average increase of the average blood flow velocity of is 17.31％. 6.Compare Experimental Group's three blood test indicators with Experimental ControlGroup's correspondingly: fibrinogen and endothelins-1 level of Experimental Groupof the 3rd day and the 7th day are both lower than those of Experimental Group's. Aperson's D-dimer of the Experimental Control Group increased significantly on the3rd day after operation, the diameter of the left calf are 1.9cm bigger than those of theright calf, gastrocnemius DVT were found by ultrasound. 7. Three people in YoungControl Group were found blood reflux, but stasis blood hidden behind the venousvalve can be cleared after both applying singly and combined applying AES and IPC,and the venous reflux can be decreased significantly; seven people in Peer ControlGroup and Experimental Group were found blood reflux, but stasis blood hiddenbehind the venous valve can be cleared after both applying singly and combined applying AES and IPC, and the venous reflux can be decreased significantly.Conclusions: By monitoring lower limb hemodynamic states of relatively healthyChinese and old Chinese of different ages who will have selective operations withfemoral neck or intertrochantoric fracture, little impact was found on the diameter offemoral venous with increasing of ages (p＞0.05, with increasing of age, the diameterincreased from 6.823±1.152mm to 7.492±1.212 and 7.337±1.650mm), but themaximum and average blood flow velocity can be decreased (P＜0.01), short time inbed (2-4days) had little impact on the diameter, the maximum and average blood flowvelocity of aged patients (P＞0.05), that is, the increasing of age can't increase thediameter, but can lower the blood flow velocity of lower limb, and injured fracture inbed patients have high risk factors of DVT, have the indicator of applying of AES andIPC, the first day in hospital should start applying. The hemodynamic effect of AES isto decrease the diameter of lower limb venous (P＜0.001), increase blood flowvelocity of lower limb venous (P＜0.001), the hemodynamic effect of IPC is toincrease blood flow velocity of lower limb venous (P＜0.001); the hemodynamiceffect of combined use of AES is not only to prevent increasing of diameter of lowerlimb venous, but to decrease diameter; not only to prevent decreasing of blood flowvelocity of lower limb venous, but to increase the blood flow velocity. 3. Thehemodynamic effect of combined applying T.E.D AES and KENDALL IPC are thatthe diameter decreased 18.2％, the maximum blood flow velocity increased 48.3％,and the average blood flow velocity increased 38.9％. Stop applying AES and IPCand measure after 30min, the diameter of femoral venous didn't change, but themaximum and average blood flow velocity didn't decrease, this proves that AES hasstrong continuum (30min) effect, so AES can be taken off in need of washing; IPChas some continuum effect but decreased (30min), the result not contradictory withTyco corporation's explanation on IPC that intermittence during application shouldnot be more than 30min. so IPC should be applied continuously for best effect. 4. Thecutted AES keeping ankle and up section have the same effect with uncutted AES, thecutted AES can increase comfort, convenience, and compliance, so AES can bechanged to anti-embolism trousers to prevent thrombosis. According to Sparrow'sproposal that the best pressure pattern is to put 4.5, 14.5, and 16.8 mmHg pressure on thigh, calf, and ankle. If the new kind of anti-embolism trousers were designed underthis pressure pattern, a better effect may be taken. 5. After applying AES singly, thediameter decreased 19.20％, the maximum blood flow velocity increased 18.09％, andthe average the average blood flow velocity increase 20.69％; after applying IPCsingly, the maximum blood flow velocity increased 22.22％, the average the averageblood flow Velocity increase 17.31％. 6. AES and IPC have reverse effect on theincreasing of fibrinogen and endothelins-1 after operation, and this benefits theprothylaxis of DVT. 7. AES and IPC can clear stasis blood hidden behind the venousvalve, and decrease the venous reflux.
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