| Objective: Venous thromboembolism(venous thromboembolism,VTE)has increasingly become an important public health problem,due to its large number of sufferers.Once formed,it will bring great pain to the patient's life,with a high mortality rate.In developing countries,VTE is currently one of the most common cardiovascular disease,about 3-6 million people suffering from the disease each year.In intensive care unit,the occurrence rate of VTE can be as high as 3%,which has become a serious problem.Here are various factors,for instance,the patients always stay in bed,combined with a variety of diseases,invasive operation,coma,hemiplegia and other thrombophilic risky factors,Venous thromboembolism(VTE)is related with three major factors,including blood hypercoagulability,vessel wall injury and blood slow flow.The use of low molecular weight heparin sodium can significantly improve blood hypercoagulable state,while using intermittent pressure charging pump(intermittent received compression IPC)can improve blood flow state.Their combined effect is better.At present,many guidelines recommend a physical and drug combination method for anticoagulation clinic,but much of the literature on the disease category is not diversified as expected.Due to patients in ICU of our hospital with many kinds of diseases and sicker state,each patient during the hospitalized period,is faced with many risky factors of VTE,therefore,anticoagulant therapy plays a key role in the hospital.Based on D-Dimer values(D-Dimer),Glasgow Coma Scale score,the Wells score,this study makes an observation on whether the method of drugs combined with physical prevention is better than the solely application of the drug in the prevention method,so as to better guide clinical work,by applying two methods of prevention of venous thrombosis on ICU patients,low molecular weight heparin and low molecular weight heparin sodium combined with intermittent pneumatic compression pumps included.Methods: Choose patients in ICU from November 2014 to March 2016,who have agreed to participate in the test and signed informed consent.They will be randomly divided into two groups.One is treatment group: treated with low molecular weight heparin sodium(5000IU,1 times / day,subcutaneously)with intermittent inflatable pressurized pump(40 mmHg,2 times / day).The other group is control group: treated with low molecular weight heparin sodium(5000IU,1 times / day subcutaneously)in the prevention of venous thrombosis,from patients enrolled to start continuously observed for 30 days,detailed records of patients age,gender,disease with.D-Dimer numerical,Glasgow score,Wells score into the set of indicators observed statistically and used on a daily basis,the Department of ultrasound examination performed on patients with lower extremity vein,for patients with cardiac ultrasonography observation of pulmonary hypertension,according to clinical symptoms and echocardiographic findings patients' severity,we decide whether CTPA works.The aim is to observe if the combination of 2 methods is better than the simple application of low molecular weight heparin sodium group.Results: The total number of people who meet the criteria is 270.In the treatment group,there are 138 people altogether,of whom 86 cases are males,with the average age of(65.11±7.27);Whereas in the Control group,there are 132 people,of whom 76 cases are males,with the average age of(66.54±6.06).The treatment group GCS score is(8.870±0.620),while the control group GCS score is(9.727±0.798);The treatment group Wells score is(1.955±0.250),while the control group Wells score is(1.864±0.281),the treatment group D-dimer(163.678±90.263),the control group D-dimer(142.79±96.032).As to the patient's age,sex ratio,D-dimer value,WELLS score and GCS score of two groups,there isn't any statistically significant difference(P > 0.05).There are 34 cases of patients with malignant tumor,16(12.1%)cases in the control group while 18 cases(13.0%)in the treatment group;There are 74 cases of patients with respiratory failure,38(28.7%)cases in the control group,and 36(26.1%)cases in the treatment group;There are 38 cases in rheumatic diseases,18 cases(13.7%)in the control group and 20(14.5%)cases in the treatment group;There are 34 cases in renal insufficiency disease,16(12.1%)in the control group,and 18 cases(13.0%)in the treatment group;There are 58 cases of diabetes,28(21.2%)cases in the control group,30(21.8%)cases in the treatment group;There are 14 cases in sepsis disease,6(4.5%)cases in the control group and 8(5.8%)cases in the treatment group;There are 18 cases of cerebral infarction,10(7.5%)cases in the control group,and 8(5.8%)cases in the treatment group.There was no significant difference between the two groups(P> 0.05).Since patients joined the group on the first day,ultrasonography examination has been undergoing for each patient every day,with the observation period lasting 30 days.In the control group,there are 15 cases patients with DVT,while in the treatment group with 3 cases occurred in patients with DVT(?2=9.157 P= 0.002).There exists statistical significance in the comparison of two groups of patients.Among the comparison of DVT occurrence rate between the control group and the observation group(P = 0.010,Log-rank=6.645),the incidence of DVT in the control group occurred earlier with more cases,which has statistically significance.Conclusion:1.Low molecular weight heparin sodium with intermittent inflatable pressurized pump to prevent venous thrombosis is safe.2.The application of low molecular weight heparin sodium with IPC can reduce the occurrence of venous thrombosis cases and reduce the incidence of venous thrombosis. |
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