预防性抗凝时机对乙型肝炎肝硬化门静脉高压并脾功能亢进患者术后静脉血栓风险的影响

The influence of preventive anticoagulation timing on the risk of postoperative venous thrombosis in patients with hepatitis B cirrhosis,portal hypertension and hypersplenism

目的研究不同时间预防性抗凝干预对乙型肝炎肝硬化门静脉高压并脾功能亢进患者术后静脉血栓风险的影响。方法纳入68例乙型肝炎肝硬化门静脉高压并脾功能亢进术患者作为研究对象,采用随机数字表法将68例患者分为观察组(n=34)和对照组(n=34)。观察组行术中抗凝干预,对照组在术后2 d行抗凝干预。记录两组手术基本情况,比较两组术后静脉血栓发生率和凝血四项水平。结果观察组术后静脉血栓发生率低于对照组(P<0.05),两组血栓严重程度无显著性差异(P>0.05)。两组术中出血量和术后拔管时间无显著性差异(P>0.05),观察组手术时间较对照组显著延长,术后住院时间较对照组显著缩短(P<0.05)。观察组术后PT、APTT及TT较对照组显著延长,Fib较对照组显著降低,差异均有统计学意义(P<0.05)。结论术中抗凝较术后2 d抗凝效果更好,有助于降低乙型肝炎肝硬化门静脉高压并脾功能亢进术患者术后静脉血栓发生率。

Objective To investigate the influence of preventive anticoagulation timing on the risk of postoperative venous thrombosis in patients with hepatitis B cirrhosis,portal hypertension and hypersplenism.Methods Sixty-eight patients with liver cirrhosis,portal hypertension and hypersplenism were included as the research objects,and divided into the observation group(n=34)and the control group(n=34)using a random number table.The observation group received anticoagulation intervention during the operation,and the control group received anticoagulation intervention2 days after the operation.The baseline characteristics of the 2 groups were recorded.The incidence of postoperative venous thrombosis and the levels of 4 coagulation indices were comparatively analyzed between the 2 groups.Results The incidence of postoperative venous thrombosis in the observation group was lower than that in the control group(P<0.05).The thrombus severity had no significant difference between the 2 groups(P>0.05),as did the bleeding volume during the operation and postoperative extubation time(all P>0.05).The operation time of the observation group was significantly longer than that of the control group,and the postoperative hospital stay was significantly shorter than that of the control group(both P<0.05).The prothrombin time,activated partial thromboplastin time and thrombin time in the observation group were significantly longer than those in the control group,the fibrinogen was significantly lower than that in the control group(all P<0.05).Conclusion In patients with liver cirrhosis,portal hypertension and hypersplenism,the effect of anticoagulation during the operation is better than 2 days after the operation,which is helpful to reduce the incidence of postoperative venous thrombosis.