Prophylactic Effects On The Optimal Time Of Intermittent Pneumatic Compression For Deep Venous Thrombosis In Patients With Hip Arthroplasty

Objective: To analyze the association between the using time of intermittent pneumatic compression(IPC)and coagulation parameters,blood loss and calf circumference in patients with total hip replacement and identify the optimal IPC time for decreasing risk of deep vein thrombosis(DVT).Methods:(1)The optimal time established based on previous systematic review of domestic and foreign databases.(2)Quality evaluation and content analysis of orthopedic guidelines related to thromboprophylaxis for preventive strategies.The final invention program was adjusted by combining with clinical status.(3)A total of 209 patients in one tertiary grade A hospital were collected by convenience sampling method to analyze the change trend and risk factors of DVT among patients undergoing total hip arthroplasty in different stages.(4)A randomized controlled trial was conducted to assess the clinical effectiveness of the interventive strategies.In terms of previous influenced factors,patients were divided into two groups according to the smallest imbalance index method.Both groups received routine thromboprophylaxis,the controlled group used IPC as usual time,while the experimental group treated by the optimal time.The thrombosis rate,perioperative blood loss,fibrinogen,d-dimer and the circumference of the lower extremity were compared between the two groups.Results:(1)Totally 6 RCTs and 4 quasi-RCTs were included.The meta-analysis well suggested that using time of IPC could be extended to 80min~360min per day[OR=3.21,95%CI(1.26,8.14),P=0.01].In consideration of small sample,the further research was needed.(2)5 topics were extracted from included guidelines cover risk screening,risk warning,prevention strategies,training demands and knowledge translation.The scores of thromboprophylaxis guidelines in orthopedics according to the domains of AGREE,from high to low,were respectively “clarity of presentations”(74.07%),“scope and purpose”(70.06%),“ participants ”(54.94%),“rigour of development”(41.64%),“applicability”(40.97%)and “editorial independence”(40.28%).(3)The overall DVT scores was 12.31~15.42 in different times.Age(?=0.229?0.383?0.273,P<0.05),obesity(?=0.315,?=0.302,P < 0.05),Charlson comorbidity index(?=0.258?0.423?0.313,P<0.05),times of hospitalization(?=0.098?0.133?0.114,P<0.05)and time staying on bed after operation(?=0.258,P<0.05)were risk factors.(4)Statistical analysis showed that using IPC once a day,each time for 30 minutes and twice a day,each time for 40 minutes could both prevent the incidence of DVT,but twice a day,each time for 40 minutes was found to be more effective in reducing calf swelling(F=6.137,P=0.022;F=24.034,P=0.000;F=18.648,P=0.000)and blood loss(t=2.739,P=0.009).Conclusion: The optimal IPC using time estimated by systematic reviews and preventive strategies extracted from clinical practice guidelines were testified under randomized trials,proving that the outcomes of patients improved with significant effects.It provides evidence-based references for clinical intervention.