Development Of Lower Limb Resistance Exercise Device And Its Effect On Femoral Venous Hemodynamics In Patients With Pancreatic Cancer After Operation

Background Deep vein thromboembolism(DVT)is a disorder of venous reflux caused by abnormal coagulation of blood in deep veins.DVT is one of the common complications of inpatients.DVT can prolong the hospitalization time and increase the cost of hospitalization.Bring heavy burden to patients and society.Advanced age,large-scale operation,tumor,and long-term bed immobility are the high risk factors of DVT,so the patients with pancreatic cancer after operation are the high-risk population of DVT.At present,physical prevention of deep venous thrombosis is commonly used in hospital.The main method is wearing graduated compression stockings(GCS)and using intermittent pneumatic compression(IPC),and doing ankle exercises.But due to comfort and compliance problems,such as improper wearing,insufficient use of time,material heat impermeability,etc.,the effect of physical prevention is reduced.Inspired by the ankle exercise assistive device designed by Japanese scholar Tanaka et al,a kind of lower extremity resistance motion assistant instrument used on the bed was developed by combining with resistance movement.Postoperative pancreatic cancer patients with early bed activity,promote lower extremity venous blood flow,to achieve the same as AE and IPC,or even better to improve the lower extremity venous blood flow dynamics.To provide a new physical prevention method for the prevention of DVT.Objectives1.The aim of the first part of this study was to draw the schematic diagram of the lower limb resistance exercise device and to turn into the real object,to improve the structure of the exercise device constantly,and finally make the lower limb resistance exercise device suitable for the patients with large abdominal surgery.2.The second part of this study was to compare the effects of different intervention methods on peak velocity,mean velocity,vessel diameter and blood flow of femoral vein in patients with pancreatic cancer.Methods1.From June 2016 to March 2017,according to the characteristics of postoperative activities of patients with pancreatic cancer,the concept of lower extremity resistive exercise device was formed,the structure of exercise device was drawn and the patent of utility model and invention type was applied for.Three generations lower limb resistance exercise instrument were made and improved successively,and the third generation improved exercise device was used to carry on the next research.2.From April to August 2017,20 patients who met the exclusion criteria were randomly divided into two groups.In one group,performed 5 minutes of resistance movement and AE to contrast,and the other group done 5 minutes of resistance exercise and IPC to contrast.The order of two different interventions in each group was also determined by a random number table.The blood flow peak velocity,mean velocity,vessel diameter and blood flow of right femoral vein were collected at baseline,0min,2 min,7 min,12 min and 20 min after exercise.Repeated measurement ANOVA was used to compare the difference of blood flow indexes between two different intervention methods in each group.Results1.October 2016 Utility Model Patent license(Patent No.ZL 2016 20 0491433.6),January 2018 Invention Patent license(Patent No.ZL 2016 1 0357756.0).2.Comparison of AE and resistance motion with device,the peak velocity of blood flow,mean velocity of blood flow and blood flow,all have the interaction between the mode of activity and the time(F = 5.478,6.700,6.111,P<0.05,respectively).There was no interaction between blood vessel diameter and time(F=0.803,P=0.499).There was no significant difference between the two intervention methods in the change of blood vessel diameter(P=0.951),but the diameter of blood vessel varied with time(P=0.000).3.Comparison of AE and resistance motion with device,the peak velocity,mean velocity of blood flow at the point of 0 min,2 min and 7min were all have significantly difference(P < 0.05),and there was significant difference in blood flow between 0min and 7min time points(P< 0.05).There were also significant differences in peak velocity,mean velocity and blood flow at different time points(P< 0.05).4.Comparison of IPC and resistance motion with device,the peak velocity,mean velocity of blood flow,diameter of blood vessel and blood flow did not interact with time(F = 0.742,1.310,0.768,1.068,respectively,P > 0.05).The main time effects of the four indexes were statistically significant(P < 0.000),but the main effects among the activity patterns were not statistically significant(P = 0.381,0.252,0.889,0.421,respectively).5.There was no significant difference(P > 0.05)in the vital signs of the patients during the exercise,which patients doing lower extremity resistance exercise with the device compared with AE or IPC.Conclusions1.The three intervention methods can improve the blood flow velocity and blood flow of femoral vein after operation.2.The 5-minute device assisted resistance exercise was no less than that of AE and IPC in improving blood flow velocity and blood flow,and the 5-minute instrumental resistance exercise was superior to that of AE in increasing blood flow velocity and blood flow and maintaining time.3.The devicet-assisted anti-resistance exercise is safe in postoperative patients with pancreatic cancer and can be used as a new physical method to prevent DVT in hospital.