空氣波壓力療法預防腦卒中患者下肢深靜脈血栓形成的研究
發(fā)布時間：2018-11-18 21:22
【摘要】：目的:探討空氣波壓力療法對腦卒中患者下肢深靜脈血流動力學和凝血功能的影響,分析空氣波壓力療法預防腦卒中患者深靜脈血栓形成的機制。本研究通過超聲檢測下肢靜脈血流動力學的變化,篩選出空氣波壓力治療儀的最適治療參數(治療模式和治療壓力)。然后將其應用于腦卒中康復治療上,檢測腦卒中患者治療前后血流動力學及凝血功能的變化情況,分析空氣波壓力療法能夠預防腦卒中患者深靜脈血栓形成的機制。方法:首先選取20名正常青年人,利用彩色多普勒超聲檢測這20名正常人在使用不同治療模式(模式A、模式B)下,不同治療壓力(40 mm Hg、60 mm Hg、80 mm Hg、100 mm Hg)的空氣波壓力治療儀干預后,不同時間段(靜息狀態(tài)下、干預后立即、干預后20分鐘、干預后40分鐘、干預后60分鐘)的左下肢股總靜脈血流動力學變化情況,從中篩選出空氣波壓力治療儀最適治療參數(治療模式和治療壓力)。然后再選取20名腦卒中患者,使用最適治療參數的空氣波壓力治療儀治療。利用彩色多普勒超聲檢測這20名腦卒中偏癱患者雙下肢在治療前后,不同時間段(靜息狀態(tài)下、干預后立即、干預后20分鐘、干預后40分鐘、干預后60分鐘)股總靜脈血流動力學變化情況和出入院時患者凝血功能指標變化情況。結果:1.基于不同治療模式和壓力的空氣波壓力療法對正常人下肢深靜脈血流動力學的研究:(1)模式A(1)組內比較:干預后四組血流峰速度、平均速度、血流量較靜息狀態(tài)下顯著增高(P0.05)。然而隨著干預結束后時間的延長,四組血流動力學指標逐漸恢復到干預前水平。(2)組間比較:四組靜息狀態(tài)下血流峰速度、血流平均速度及血流量比較差異無統(tǒng)計學意義(P0.05);干預結束后40 min內四組間血流峰速度、血流平均速度及血流量比較差異有統(tǒng)計學意義(P0.05),干預后60 min四組間血流峰速度和血流平均速度比較差異有統(tǒng)計學意義(P0.05),血流量比較差異無統(tǒng)計學意義(P0.05)。(2)模式B(1)組內比較:干預后四組血流峰速度、平均速度、血流量較靜息狀態(tài)下顯著增高(P0.05)。然而隨著干預結束后時間的延長,四組血流動力學指標逐漸恢復到干預前水平。(2)組間比較:靜息狀態(tài)下四組血流峰速度、血流平均速度及血流量比較差異無統(tǒng)計學意義(P0.05);干預結束后40 min內四組間血流峰速度、血流平均速度及血流量比較差異有統(tǒng)計學意義(P0.05),干預后60 min四組間血流動力學指標比較差異無統(tǒng)計學意義(P0.05)。2.基于空氣波壓力療法預防腦卒中患者下肢深靜脈血栓形成的研究:(1)靜息狀態(tài)下健患側比較入院:與健側相比患側血流峰速度、血流平均速度顯著降低(P0.05),健患側血流量比較差異無統(tǒng)計學意義(P0.05),出院時健患側比較結果同入院。(2)血流動力學變化情況入院:干預后健患側血流峰速度、平均速度、血流量較靜息狀態(tài)下顯著增高(P0.05),然而隨著干預結束后時間的延長,健患側血流動力學指標逐漸減慢,其中患側血流動力學指標在干預結束40分鐘后逐漸恢復到靜息水平。出院:健患側血流動力學指標變化情況,基本與治療前相同。(3)凝血功能比較與入院相比出院時纖維蛋白原含量明顯降低(P0.05),其余凝血功能指標比較差異無統(tǒng)計學意義(P0.05)。結論:1.空氣波壓力治療儀在工作模式A,治療壓力為80mm Hg時,促進靜脈血液回流的效果最佳,對正常人而言停用空氣波壓力治療儀60分鐘時靜脈血流動力學指標接近使用前水平;2.空氣波壓力療法能夠促進腦卒中患者下肢血液的回流,改善下肢靜脈血液瘀滯的情況,患肢的治療效果可持續(xù)至干預結束后40分鐘;3.重復使用空氣波壓力療法不會延長加速靜脈血液回流的持續(xù)時間,但是能夠改善凝血功能;4.建議腦卒中患者健患側均接受IPC治療,以便更好的降低DVT形成的風險。
[Abstract]:Objective: To study the effect of air wave pressure therapy on the hemodynamics and coagulation of lower limbs of patients with stroke, and to analyze the mechanism of air wave pressure therapy in the prevention of deep venous thrombosis in patients with stroke. The optimal treatment parameters (treatment mode and treatment pressure) of the air wave pressure therapeutic apparatus were selected by the change of the flow dynamics of the venous blood of the lower limbs by means of ultrasound. Then it is applied to the treatment of stroke rehabilitation, and the changes of blood flow dynamics and coagulation function before and after the treatment of stroke patients are detected, and the mechanism of the formation of deep vein thrombosis in patients with stroke can be prevented by the analysis of air wave pressure therapy. Methods: 20 normal young people were selected, and the 20 normal persons were detected by color Doppler ultrasound in different treatment modes (mode A and mode B). After the intervention of the air wave pressure therapeutic apparatus with different treatment pressure (40 mm Hg, 60 mm Hg, 80 mm Hg, 100 mm Hg), The optimal treatment parameters (treatment mode and treatment pressure) of the air wave pressure therapeutic apparatus were selected for different time periods (at rest, immediately after intervention, 20 minutes after intervention, 40 minutes after intervention, and 60 minutes after intervention). Then, 20 stroke patients were selected, and the optimal treatment parameters were used for the treatment of the air wave pressure therapeutic apparatus. The two lower limbs of the 20 stroke patients with hemiplegia were detected by color Doppler ultrasound before and after treatment, in different time periods (resting state, immediately after intervention, 20 minutes after intervention, and 40 minutes after the intervention, The changes of blood flow dynamics in the total venous blood flow in 60 minutes after intervention and the change of the coagulation function of the patients at the time of the entrance and exit. Results: 1. The study of air wave pressure therapy based on different treatment modes and pressure on the hemodynamics of the deep venous blood of the lower limbs of the normal person: (1) The comparison of the model A (1): the velocity of the four groups of blood flow, the average speed and the blood flow in the four groups after the intervention were significantly higher than those in the rest state (P0.05). However, with the extension of time after the end of the intervention, the four groups of hemodynamic indexes were gradually restored to the pre-intervention level. (2) There was no significant difference in the blood flow peak velocity, the average velocity of the blood flow and the blood flow in the four groups at rest (P0.05), and the difference of the blood flow peak velocity, the average velocity of the blood flow and the blood flow in the four groups after the intervention was statistically significant (P0.05). There was no significant difference in the velocity of blood flow and the average velocity of blood flow at 60 min after intervention (P0.05), and the difference of blood flow was not significant (P0.05). (2) In group B (1) group, the velocity, mean velocity and blood flow of four groups of blood flow were significantly higher than those in the rest (P0.05). However, with the extension of time after the end of the intervention, the four groups of hemodynamic indexes were gradually restored to the pre-intervention level. (2) There was no significant difference in the velocity of blood flow, the average velocity of blood flow and the flow of blood flow in the four groups at rest (P0.05), and there was a significant difference in the velocity of blood flow, the average velocity of blood flow and the flow of blood flow within 40 minutes after the end of the intervention (P0.05). There was no significant difference in the hemodynamic indexes between the four groups after the intervention (P0.05). A study on the prevention of deep venous thrombosis in the lower extremities of patients with stroke based on air-wave pressure therapy: (1) In resting state, the patient was admitted to the hospital: the velocity of the side blood flow and the average velocity of the blood flow were significantly lower than that of the healthy side (P0.05). There was no significant difference in the blood flow between the healthy and healthy side (P <0.05), and the result of the patient's side comparison at the time of discharge was the same as that of the hospital. (2) The changes of blood flow dynamics were admitted: the peak velocity, the average velocity and the blood flow in the post-intervention group were significantly higher than that of the rest (P0.05). However, with the prolongation of the time after the end of the intervention, the hemodynamic index of the healthy side was gradually reduced. At the end of the intervention, the hemodynamic index was gradually restored to the resting level. Discharge: The change of the hemodynamic index on the patient side is basically the same as before treatment. (3) The blood coagulation function was significantly lower than that of admission (P0.05), and the other coagulation function indexes were not statistically significant (P0.05). Conclusion: 1. When the air wave pressure therapeutic apparatus is in the working mode A, the treatment pressure is 80mm Hg, the effect of promoting the venous blood reflux is the best, and the hemodynamic index of the venous blood is close to the pre-use level when the air wave pressure therapeutic apparatus is stopped for 60 minutes for the normal person; and 2. The air wave pressure therapy can promote the return of the blood in the lower limbs of the patients with stroke, improve the blood stasis in the venous blood of the lower limbs, and the treatment effect of the patients with the limb can be continued until the end of the intervention for 40 minutes; and 3. Repeated use of air wave pressure therapy does not prolong the duration of accelerated venous blood reflux, but can improve the coagulation function; 4. It is recommended that the patient side of the stroke patient receive the IPC treatment in order to better reduce the risk of DVT formation.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2341286
[Abstract]:Objective: To study the effect of air wave pressure therapy on the hemodynamics and coagulation of lower limbs of patients with stroke, and to analyze the mechanism of air wave pressure therapy in the prevention of deep venous thrombosis in patients with stroke. The optimal treatment parameters (treatment mode and treatment pressure) of the air wave pressure therapeutic apparatus were selected by the change of the flow dynamics of the venous blood of the lower limbs by means of ultrasound. Then it is applied to the treatment of stroke rehabilitation, and the changes of blood flow dynamics and coagulation function before and after the treatment of stroke patients are detected, and the mechanism of the formation of deep vein thrombosis in patients with stroke can be prevented by the analysis of air wave pressure therapy. Methods: 20 normal young people were selected, and the 20 normal persons were detected by color Doppler ultrasound in different treatment modes (mode A and mode B). After the intervention of the air wave pressure therapeutic apparatus with different treatment pressure (40 mm Hg, 60 mm Hg, 80 mm Hg, 100 mm Hg), The optimal treatment parameters (treatment mode and treatment pressure) of the air wave pressure therapeutic apparatus were selected for different time periods (at rest, immediately after intervention, 20 minutes after intervention, 40 minutes after intervention, and 60 minutes after intervention). Then, 20 stroke patients were selected, and the optimal treatment parameters were used for the treatment of the air wave pressure therapeutic apparatus. The two lower limbs of the 20 stroke patients with hemiplegia were detected by color Doppler ultrasound before and after treatment, in different time periods (resting state, immediately after intervention, 20 minutes after intervention, and 40 minutes after the intervention, The changes of blood flow dynamics in the total venous blood flow in 60 minutes after intervention and the change of the coagulation function of the patients at the time of the entrance and exit. Results: 1. The study of air wave pressure therapy based on different treatment modes and pressure on the hemodynamics of the deep venous blood of the lower limbs of the normal person: (1) The comparison of the model A (1): the velocity of the four groups of blood flow, the average speed and the blood flow in the four groups after the intervention were significantly higher than those in the rest state (P0.05). However, with the extension of time after the end of the intervention, the four groups of hemodynamic indexes were gradually restored to the pre-intervention level. (2) There was no significant difference in the blood flow peak velocity, the average velocity of the blood flow and the blood flow in the four groups at rest (P0.05), and the difference of the blood flow peak velocity, the average velocity of the blood flow and the blood flow in the four groups after the intervention was statistically significant (P0.05). There was no significant difference in the velocity of blood flow and the average velocity of blood flow at 60 min after intervention (P0.05), and the difference of blood flow was not significant (P0.05). (2) In group B (1) group, the velocity, mean velocity and blood flow of four groups of blood flow were significantly higher than those in the rest (P0.05). However, with the extension of time after the end of the intervention, the four groups of hemodynamic indexes were gradually restored to the pre-intervention level. (2) There was no significant difference in the velocity of blood flow, the average velocity of blood flow and the flow of blood flow in the four groups at rest (P0.05), and there was a significant difference in the velocity of blood flow, the average velocity of blood flow and the flow of blood flow within 40 minutes after the end of the intervention (P0.05). There was no significant difference in the hemodynamic indexes between the four groups after the intervention (P0.05). A study on the prevention of deep venous thrombosis in the lower extremities of patients with stroke based on air-wave pressure therapy: (1) In resting state, the patient was admitted to the hospital: the velocity of the side blood flow and the average velocity of the blood flow were significantly lower than that of the healthy side (P0.05). There was no significant difference in the blood flow between the healthy and healthy side (P <0.05), and the result of the patient's side comparison at the time of discharge was the same as that of the hospital. (2) The changes of blood flow dynamics were admitted: the peak velocity, the average velocity and the blood flow in the post-intervention group were significantly higher than that of the rest (P0.05). However, with the prolongation of the time after the end of the intervention, the hemodynamic index of the healthy side was gradually reduced. At the end of the intervention, the hemodynamic index was gradually restored to the resting level. Discharge: The change of the hemodynamic index on the patient side is basically the same as before treatment. (3) The blood coagulation function was significantly lower than that of admission (P0.05), and the other coagulation function indexes were not statistically significant (P0.05). Conclusion: 1. When the air wave pressure therapeutic apparatus is in the working mode A, the treatment pressure is 80mm Hg, the effect of promoting the venous blood reflux is the best, and the hemodynamic index of the venous blood is close to the pre-use level when the air wave pressure therapeutic apparatus is stopped for 60 minutes for the normal person; and 2. The air wave pressure therapy can promote the return of the blood in the lower limbs of the patients with stroke, improve the blood stasis in the venous blood of the lower limbs, and the treatment effect of the patients with the limb can be continued until the end of the intervention for 40 minutes; and 3. Repeated use of air wave pressure therapy does not prolong the duration of accelerated venous blood reflux, but can improve the coagulation function; 4. It is recommended that the patient side of the stroke patient receive the IPC treatment in order to better reduce the risk of DVT formation.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
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