不同季节关节置换术及关节置换术后疼痛评分与下肢深静脉血栓发生率的关系

发布时间：2018-05-30 16:15

  本文选题：季节 + 关节置换　； 参考：《南京大学》2017年硕士论文

【摘要】：第一部分:不同季节关节置换术后下肢深静脉血栓形成发生率的差异目的:探讨不同季节进行全膝关节置换或全髋关节置换术后下肢深静脉血栓形成(deep vein thrombosis,DVT)发生率的差异。方法:采用回顾性研究方法,纳入2008年8月至2016年2月共2 363例初次全膝或全髋关节置换患者,男653例,女1 710例;年龄17～91岁。术后3～5天常规行双侧下肢深静脉造影排查血栓。按手术季节和年龄(≥65岁、65岁)进行分组,比较不同组别患者术后DVT和症状性DVT发生率的差异。结果:春夏秋冬四季关节置换术后DVT的发生率分别为15.85%、14.92%、17.88%和22.50%,差异有统计学意义(P=0.005);春、夏、秋、冬四季全膝关节置换术后DVT发生率分别为19.09%、15.67%、18.11%和27.71%,差异有统计学意义(P=0.022);春、夏、秋、冬四季节全髋关节置换术后DVT发生率分别为13.48%、14.17%、17.73%和20.26%,差异有统计学意义(P=0.044)。春、夏、秋、冬四季关节置换术后症状性DVT的发生率分别为3.55%、3.78%、4.97%和 6.90%,差异有统计学意义(P=0.0245);春、夏、秋、冬四季全膝关节置换术后症状DVT的发生率分别为3.88%、4.24%、4.94%、9.64%,差异有统计学意义(P=0.043);春、夏、秋、冬四季全髋关节置换术后症状性DVT的发生率分别为3.31%、3.33%、4.99%、5.71%,差异无统计学意义(P0.05)。年龄≥65岁组术后DVT的发生率在春夏秋冬四季分别为18.49%、16.61%、22.07%、28.05%,差异有统计学意义(P=0.002);症状性DVT发生率分别是4.38%、4.43%、5.72%、8.78%,差异有统计学意义(P=0.043)。而年龄65岁组术后DVT的发生率在春夏秋冬不同季节分别为12.46%、12.68%、11.39%、12.63%,差异无统计学意义(P0.05);症状性DVT发生率分别为2.49%、2.93%、3.80%、3.54%,差异无统计学意义(P0.05)。结论:不同季节关节置换术后DVT发生率不同,冬季DVT发生率最高。但季节对关节置换术后DVT的影响主要出现在65岁以上患者。第二部分:关节置换术后疼痛评分与下肢深静脉血栓发生率的关系目的:探讨全膝关节置换或全髋关节置换术后疼痛评分与患者深静脉血栓(deep vein thrombosis,DVT)发生率的关系。方法:本研究采用回顾结合前瞻的方法,回顾分析2010年3月至2014年8月,共计1 445例初次单侧全膝关节置换或全髋关节置换患者,所有患者均在术后3～5天行双侧下肢静脉造影,造影前当天早上行视觉模拟评分法(visual analogue scale,VAS)进行评分。VAS评分范围(0～10分,(0～3)分表示轻度疼痛,(4～10)分表示中重度疼痛。前瞻研究选自2016年2月至2016年9月的343例初次单侧全膝或全髋关节置换患者。术后第1天,第3天,第7天或出院前,术后6周和术后3月时分别行彩超检查,并对患者采用VAS疼痛评分,评分项目包括白天痛、夜间痛、静息痛和活动痛。结果:回顾分析1 445例全膝或全髋关节置换患者,男性439例,女性1 006例,平均年龄64.98 岁。其中 233 例(16.12%)DVT 患者,1 212 例(83.88%)非 DVT 患者。DVT组VAS评分3.34±1.43,非DVT组VAS评分2.97±1.29,差异具有统计学意义(P0.001)。轻度疼痛组900例,DVT发生率13.00%;中重度疼痛组545例,DVT发生率21.28%,差异具有统计学意义(P0.001)。VAS评分与血栓发生率进行相关分析,相关系数r=0.86,P0.01。前瞻研究共计343例全膝或全髋关节置换患者。术后第1天,第3天,第7天或出院前,术后6周和术后3月的DVT组和非DVT组的白天痛、夜间痛、静息痛和活动痛VAS评分进行分析,在术后第7天时DVT组和非DVT组在白天痛和活动痛的VAS评分上有统计学差异(两个P值都0.001),其它没有统计学差异。分别按照白天痛、夜间痛、静息痛和活动痛VAS评分分为轻度疼痛组和中重度疼痛组,白天痛和活动痛的轻度疼痛组和中重度疼痛组在术后第7天时的DVT发生率有统计学差异(两个P0.05),其它组没有统计学差异。结论:关节置换术后的疼痛评分与血栓发生存在很大的相关性,DVT组的疼痛评分高于非DVT组,并且中重疼痛组的DVT发生率高于轻度疼痛组。在疼痛与DVT的关系中,术后第7天的白天痛和活动痛意义最大。
[Abstract]:Part one: differences in the incidence of deep venous thrombosis after arthroplasty in different seasons. Objective: To explore the difference in the incidence of deep venous thrombosis (deep vein thrombosis, DVT) after total knee replacement or total hip replacement in different seasons. Methods: a retrospective study was taken from August 2008 to 2 in 2016. There were 2363 cases of total knee or total hip replacement, 653 men, 1710 women, 1710 women, 17~91 years old. 3~5 days after operation, bilateral deep venous angiography was performed to check thrombus. According to the operation season and age (65 years old, 65 years old), the differences in the incidence of DVT and symptomatic DVT in different groups were compared. Results: spring, summer, autumn and winter four. The incidence of DVT after arthroplasty was 15.85%, 14.92%, 17.88% and 22.50% respectively. The difference was statistically significant (P=0.005). The incidence of DVT after total knee arthroplasty in spring, summer, autumn and winter was 19.09%, 15.67%, 18.11% and 27.71%, respectively (P=0.022); the incidence of DVT in spring, summer, autumn and winter four season after total hip arthroplasty was found. The difference was 13.48%, 14.17%, 17.73% and 20.26% respectively (P=0.044). The incidence of symptomatic DVT after arthroplasty in spring, summer, autumn and winter was 3.55%, 3.78%, 4.97% and 6.90% respectively (P=0.0245); the incidence of DVT after total knee arthroplasty in spring, summer, autumn and winter was 3.88%, 4.24%, 4.94%, respectively. 9.64%, the difference was statistically significant (P=0.043); the incidence of symptomatic DVT in spring, summer, autumn, and winter after total hip replacement was 3.31%, 3.33%, 4.99%, 5.71%, respectively (P0.05). The incidence of DVT in the group of older than 65 years old was 18.49%, 16.61%, 22.07%, 28.05%, respectively (P=0 .002); the incidence of symptomatic DVT was 4.38%, 4.43%, 5.72%, 8.78%, and the difference was statistically significant (P=0.043). The incidence of DVT in the 65 year old group was 12.46%, 12.68%, 11.39%, 12.63%, respectively (P0.05), and the incidence of symptomatic DVT was 2.49%, 2.93%, 3.80%, 3.54%, and no statistical difference. P0.05. Conclusion: the incidence of DVT after arthroplasty in different seasons is different, and the incidence of DVT in winter is the highest. But the effect of season on DVT after arthroplasty is mainly in patients over 65 years. The second part: the relationship between pain score after joint replacement and the incidence of deep venous thrombosis of lower extremity: total knee replacement or total hip arthroplasty The relationship between pain score and the incidence of deep vein thrombosis (DVT) after joint replacement. Methods: a retrospective and prospective method was used in this study to review and analyze 1445 cases of primary unilateral total knee replacement or total hip replacement from March 2010 to August 2014. All patients were performed on 3~5 days after operation. Side and lower limb venography, visual analogue scale (VAS) was performed on the same morning before the contrast (0~10 points, 0~3) for mild pain, and (4~10) to represent moderate and severe pain. Prospective study was selected from February 2016 to September 2016 for the first unilateral total knee or total hip replacement patients. Color Doppler ultrasonography was performed at first days, third days, seventh days, or before discharge, 6 weeks after operation and March after operation, and VAS pain scores were used in patients. The scores included daytime pain, nocturnal pain, resting pain and activity pain. Results: retrospective analysis of 1445 patients with total knee or total hip replacement, 439 men, 1006 women, and 64.98 years of average age. 233 Cases (16.12%) DVT patients, 1212 cases (83.88%) non DVT patients,.DVT group VAS score 3.34 + 1.43, non DVT group VAS score 2.97 + 1.29, the difference was statistically significant (P0.001). Mild pain group 900 cases, DVT incidence of 13%; moderate and severe pain group 545 cases, DVT incidence 21.28%, difference has statistical significance (P0.001).VAS score and thrombus incidence into the incidence Correlation analysis, correlation coefficient r=0.86, P0.01. prospective study total of 343 patients with total knee or total hip replacement. First days, third days, seventh days, 6 weeks after operation, 6 weeks after operation, day pain, nocturnal pain, resting pain and activity pain VAS score in group DVT and non DVT after operation, and in group DVT and non DVT group in day seventh days after operation. The VAS scores of pain and activity pain were statistically different (two P values were 0.001), and there were no other statistical differences. The VAS scores were divided into mild and moderate and severe pain groups according to daytime pain, nocturnal pain, resting pain and activity pain, and the incidence of DVT in the mild and severe pain groups of daytime and activity pain and moderate to severe pain groups at seventh days after the operation. Statistical differences (two P0.05) were not statistically significant in other groups. Conclusion: pain scores after arthroplasty were significantly correlated with thrombosis. The pain scores in group DVT were higher than those in the non DVT group, and the incidence of DVT in the medium heavy pain group was higher than that in the mild pain group. In the relationship between pain and DVT, the pain and activity of daytime after seventh days after the operation The pain is the greatest.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
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本文编号：1955923