神经手术病人深静脉血栓的预防Prevention of Deep Vein Thrombosis in potential Neurosurgical PatientsA Randomized Trial Comparing Graduated Compression Stockings Alone or Graduated Compression Stockings Plus Intermittent pneumatic Compression With Control Alexander G. G. Turpie, FRCP; Jack Hirsh, MD;Michael Gent, MS; Denise Julian, MS; Judith Johnson, RN In a randomized trial of neurosurgical patients, groups wearing graduated compression stockings alone (group 1) or graduated compression stockings plus Intermittent pneumatic compression (IPC) (group 2) were compared with an untreated control group In the prevention of deep vein throm-b0sis (DVT). In both active treatment groups, the graduated compression stockings were continued for 14 days or until hospital discharge, if earlier. In group 2, IPC was continued for seven days. All patients underwent DVT surveillance with iodine 125-labeled fibrlnogen leg scanning and Impedance plethysmogrephy. Venography was carried out if either test became abnormal. Deep vein thrombosis occurred in seven (8.8%) of 80 patients in group 1, in seven (9.0%) of 78 patients in group 2, and in 16 (19.8%) of 81 patients in the control group. The observed differences among these rates are statistically significant. The results of this study indicate that graduated compression stockings alone or in combination with IPC are effective methods of preventing DVT In neurosurgical patients. (Arch Intern Med 1989;149:679-681 )Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common causes of morbidity and mortality in neurosurgical patients. The incidence of DVT detected by iodine I 125-labeled fibrinogen leg scanning and impedance plethysmography (IPG) in neurosurgical populations has been reported to be 20% to 30%. Fatal PE occurs in approximately 1% of neurosurgical patients. Several methods for preventing DVT following neurosurgery are available, but the most attractive are the physical methods, including graduated compression stock-rugs or intermittent pneumatic compression (IPC) devices Anticoagulant prophylaxis with low-dose heparin is effective in general surgical patients, but the use of anticoagulants in neurosurgical patients is problematic because of the potential for serious bleeding. Antiplatelet drugs have not been universally effective for thrombosis prophylaxis and are not widely used. In a recent study in neurosurgical patients, suloctidil, a new antiplatelet drug, was found to be ineffective in preventing DVT. Intermittent pneumatic compression is an effective method of prophylaxis in both general surgical patients and neurosurgical patients. Despite its demonstrated efficacy, IPC is not widely used for the prevention of DVT in neurosurgical patients, possibly because of the perception that it is inconvenient to both patients and nursing staff.Accepted for publication June 7, 1988. From the Departments of Medicine (Drs Turpie and Hirsh) and Clinical Epidemiology and Biostatistics (Mr Gent and Ms Julian), McMaster University, and Hamilton General Hospital (Dr Turpie and Ms Johnson), Hamilton, Ontario, Canada. Reprint requests to McMaster Clinic, Hamilton General Hospital, 237 Barton St E, Hamilton, Ontario, Canada L8L 2X2 (Dr Turpie). Arch Intern Med-Vo1149, March 1989 Graduated compression stockings, which are much easier to use, are also effective in the prevention of DVT in general surgical patients.8-12 However, it is not known whether graduated compression stocking prophylaxis is effective in neurosurgical patients or whether the combination of graduated compression plus IPC prophylaxis would give additional protection against thrombosis in these patients. We have therefore performed a randomized clinical trial for the prevention of DVT in neurosurgical patients comparing graduated compression stockings alone or graduated compression stockings plus IPC with a control group receiving standard physiotherapy. PATIENTS AND METHODS Consecutive patients 16 years of age or older admitted to the Regional Neurosciences Centre, Hamilton, Ontario, Canada, with brain tumor, spinal cord tumor, head injury, spinal cord injury, or subarachnoid hemorrhage were eligible for entry into the study. Patients were excluded if they had a history of allergy to iodine, multiple trauma involving the legs so that IPG or leg scanning could not be performed, a mild head injury requiring only 24 hours of observation, a condition that required anticoagulant therapy, or an initial abnormal IPG. Treatment Intervention Prior to randomization, patients were stratifiedby hospital admission diagnosis: brain tumor, spinal cord tumor, head injury, spinal cord injury, or subarachnoid hemorrhage; they were then assigned, according to a prescribed randomized arrangement using sealed envelopes, to one of three treatment groups. These were as follows: (1) graduated compression stockings alone, (2) graduated com