腰椎术后那曲肝素钙预防下肢深静脉血栓的临床研究

Clinical study on the prevention of deep vein thrombosis by using Naquheparin calcium after lumbar spine surgery

目的:探讨腰椎术后使用那曲肝素钙预防下肢深静脉血栓(deep venous thrombosis,DVT)的疗效和安全性。方法:选取2021年1月―2022年12月在我院行腰椎手术患者78例,随机分为对照组(n=39)和观察组(n=39),对照组患者单纯使用物理预防措施预防深静脉血栓,观察组患者在物理预防措施基础上,术后12 h使用低分子那曲肝素钙预防深静脉血栓。比较两组患者术中出血量及术后切口内引流量、切口渗血及深部血肿发生情况;比较两组患者术前、术后第3 d及第7 d凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)等指标;采用B超检查记录术前及术后7~10 d内双下肢深静脉血栓发生情况。结果:两组患者术中出血量及术后伤口引流量无明显差异;术前两组患者凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)指标结果比较无明显差异;两组患者术后3 d、术后7 d凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)指标相比,结果无明显差异;观察组患者术后3 d、术后7 d纤维蛋白原(FIB)和D-二聚体(DD)明显低于对照组。术后对照组出现有症状深静脉血栓1例和无症状小腿肌间静脉血栓2例,而观察组术后没有深静脉血栓发生。结论:腰椎术后使用低分子那曲肝素钙不增加椎管内出血风险,使用低分子那曲肝素钙可以降低纤维蛋白原(FIB)和D-二聚(DD)体指标,以预防腰椎术后下肢深静脉血栓形成。

Objective To explore the safety and efficacy of low molecular Naqu heparin calcium in the prevention of deep vein thrombosis after lumbar spine surgery.Methods 78 Patients with lumbar spine surgery were randomly divided into observation group and control group.The patients of control group used physical prophylaxis to prevent deep vein thrombosis.The observation group used low-molecular Naqu heparin calcium to prevent DVT based on physical prophylaxis 12 hours after surgery.The amount of bleeding during the operation,the amount of drainage in the incision after the operation,the incisional bleeding and the occurrence of deep hematoma were recorded.The parameters of thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer(DD)were recorded before and 3 and 7 days after operation.Ultrasonography was performed to record the thrombosis of the lower extremities before and 7-10 after the operation.Results There was no significant difference in the amount of blood loss during operation and the amount of wound drainage after operation between the two groups(P>0.05).There was no significant difference in the results of thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer(DD)between the two groups before operation(P>0.05).There was no significant difference in prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)between the two groups at 3 days and 7 days post-operation(P>0.05).There were significant differences in fibrinogen(FIB)and D-dimer(DD)between observation group and control group at 3 days and 7 days post-operation,the levels of fibrinogen(FIB)and D-dimer(DD)in the observation group were significantly lower than those in the control group(P<0.05).In control group a DVT with symptom and two intermuscular vein thrombosis of shank with no symptom were taken place,and there was no DVT occur in observation group.Conclusion Using low-molecular Naqu heparin calcium does not increase the risk of intraspinal bleeding after lumbar spine surgery.it can reduce fibrinogen(FIB)and D-dimer(DD)levels,thus playing a role in preventing deep vein thrombosis in both lower limbs after lumbar spine surgery.