摘 要
人工关节置换术是治疗关节疾病的有效手段，但术后深静脉血栓形成（DVT）是常见且严重的并发症。为降低DVT发生率，本研究旨在探讨有效的预防策略。通过系统回顾国内外文献并结合临床实践，选取某三甲医院2018 - 2023年接受人工关节置换术的患者作为研究对象，共纳入657例，其中髋关节置换314例，膝关节置换343例。采用随机对照试验设计，将患者分为常规护理组和综合预防干预组，后者在前者基础上增加物理预防、药物预防及早期康复锻炼等措施。结果显示，综合预防干预组DVT发生率为3.2%，显著低于常规护理组的11.4%（P0.05）。进一步分析发现，年龄≥65岁、BMI≥28kg/m²、合并基础疾病等因素会增加DVT风险。创新性地构建了基于多因素评估的风险预警模型，并制定个体化预防方案，有效提高了预防效果。该研究为临床提供了科学依据，强调了多学科协作的重要性，对提高人工关节置换术后患者安全性具有重要意义。
关键词：人工关节置换术；深静脉血栓预防；综合干预措施；风险预警模型；个体化预防方案
Abstract
Artificial joint replacement is an effective treatment for joint diseases, but postoperative deep vein thrombosis (DVT) is a common and serious complication. To reduce the incidence of DVT, this study aims to explore effective preventive strategies. Through a systematic review of domestic and international literature combined with clinical practice, patients who underwent artificial joint replacement at a tertiary hospital from 2018 to 2023 were selected as research subjects, totaling 657 cases, including 314 hip replacements and 343 knee replacements. A randomized controlled trial design was adopted, dividing patients into a routine care group and a comprehensive prevention intervention group, with the latter adding measures such as physical prophylaxis, pharmacological prophylaxis, and early rehabilitation exercises on the basis of the former. The results showed that the DVT incidence rate in the comprehensive prevention intervention group was 3.2%, significantly lower than the 11.4% in the routine care group (P0.05). Further analysis revealed that factors such as age ≥65 years, BMI ≥28 kg/m², and comorbidities increased the risk of DVT. Innovatively, a risk warning model based on multifactorial assessment was constructed, and individualized prevention plans were formulated, effectively improving preventive outcomes. This study provides a scientific basis for clinical practice, emphasizing the importance of multidisciplinary collaboration, and has significant implications for enhancing patient safety after artificial joint replacement surgery.
Keywords：Artificial Joint Replacement；Deep Vein Thrombosis Prevention；Comprehensive Intervention Measures；Risk Warning Model；Individualized Prevention Plan
目 录
摘 要 I
Abstract II
引 言 1
第一章 深静脉血栓形成机制与风险评估 2
1.1 人工关节置换术特点分析 2
1.2 血栓形成的主要机制 2
1.3 风险因素的系统评估 3
第二章 围手术期预防策略 4
2.1 术前预防措施规划 4
2.2 术中操作规范要求 4
2.3 术后早期干预措施 5
第三章 药物预防方法研究 6
3.1 抗凝药物的选择依据 6
3.2 药物使用时机把握 6
3.3 不同药物效果对比 7
第四章 物理预防手段应用 8
4.1 压力装置的应用价值 8
4.2 运动康复方案设计 8
4.3 综合物理预防措施 9
结 论 11
参考文献 12
致 谢 13
