妇科肿瘤深静脉置管患者低分子肝素治疗对静脉血栓栓塞的预防价值

Significance of low molecular weight heparin in preventing VTE in patients with gynecologic tumors undergoing deep venous catheterization

目的探讨妇科肿瘤深静脉置管(PICC)患者应用低分子肝素治疗对静脉血栓栓塞(VTE)的预防价值。方法选取2015年4月至2019年6月间上海复旦大学附属中山医院青浦分院收治的因妇科肿瘤而需要进行PICC置管的124例患者。采用随机数表法分为研究组和常规组,每组62例。研究组患者在置管后3d内给予患者低分子肝素治疗,常规组患者置管后采用常规护理及治疗。观察两组患者的静脉血栓栓塞(VTE)发生率和治疗前后的凝血功能,比较两组患者治疗前后的血小板(PLT)、血红蛋白(Hb)、D-二聚体(D-D)和纤维蛋白原(FIB)水平,并比较两组患者治疗前后的下肢周径与血流速度。结果与治疗前相比,常规组患者治疗后凝血功能指标均降低,而研究组患者治疗后均升高,差异均有统计学意义(均P<0.05)。研究组患者治疗后凝血功能指标均高于常规组患者,差异均有统计学意义(均P<0.05)。治疗前,两组患者PLT、Hb、D-D和FIB水平比较,差异无统计学意义(P>0.05)。治疗后,两组患者血清指标水平PLT、Hb和FIB比较,差异无统计学意义(P>0.05);研究组患者D-D水平低于对照组患者,差异有统计学意义(P<0.05)。常规组患者治疗后血流速度明显低于治疗前,下肢周径显著高于治疗前,差异均有统计学意义(均P<0.05)。研究组患者治疗后血流速度和下肢周径与治疗前相比,差异无统计学意义(P>0.05)。治疗后,研究组患者血流速度显著高于常规组患者,下肢周径显著低于常规组,差异均有统计学意义(均P<0.05)。治疗后常规组患者VTE发生例数为9例,发生率为14.5%,高于研究组患者的3.2%,差异有统计学意义(P<0.05)。结论妇科肿瘤深静脉置管患者应用低分子肝素能够显著降低VTE的发生,可有效提高患者的抗凝功能,改善血流速度。

Objective To study the significance of low molecular weight heparin in preventing venous thromboembolism(VTE)in patients with gynecologic tumors undergoing peripherally inserted central catheter(PICC)placement.Methods A total of 124 patients undergoing PICC placement for gynecologic tumors who admitted to Fudan University Affiliated Zhongshan Hospital Qingpu Branch from April 2015 to July 2019 in our hospital were selected.The random number table method was used to divide them into a study group and a conventional group with 62 patients in each group.Patients in the study group were given low molecular weight heparin within 3 days after PICC placement.Patients in the conventional group received routine care and treatment after the surgery.The incidence of venous thromboembolism(VTE)was observed in the two groups.The coagulation function was compared between the two groups before and after treatment.Platelets(PLT),hemoglobin(Hb),D-dimer(D-D)and fibrinogen(FIB)levels were detected.The lower limb circumference and blood flow velocity were compared between the two groups before and after treatment.Results The coagulation function indexes increased in the study group but decreased in the conventional group compared with before the treatment(all P<0.05).The coagulation function indexes were significantly higher in the study group than in the conventional group(all P<0.05).Before the treatment,there was no significant difference in the levels of PLT,Hb,D-D and FIB between the two groups(P>0.05).After the treatment,there was no significant difference in the levels of PLT,Hb and FIB between the two groups(P>0.05).However,the level of D-D was lower in the study group than in the conventional group(P<0.05).After treatment,blood flow velocity decreased but lower limb circumference increased in the conventional group compared with before the treatment(all P<0.05).However,there was no significant difference in the blood flow velocity and lower limb circumference in the study group before and after the treatment(P>0.05).In general,blood flow velocity was significantly higher in the study group than in the conventional group and the lower limb circumference was lower in the study group than in the conventional group(all P<0.05).After treatment,VTE occurred in 9 patients and the incidence was14.5%in the conventional group.In the study group,the incidence of VTE was 3.2%(P<0.05).Conclusion Low molecular weight heparin can significantly reduce the incidence of VTE,effectively improve the anticoagulant function and blood flow velocity in patients with gynecologic tumors undergoing peripherally inserted central catheter placement.