高血压脑出血手术后深静脉血栓栓塞症预防性治疗

Prophylactic treatment for deep vein thrombosis after hypertensive intracerebral hemorrhage operation using low dose of low-molecular-weight heparin combined with compression stockings

目的评估高血压脑出血病人在围手术期皮下注射低剂量低分子肝素结合穿戴弹力袜预防深静脉血栓栓塞症的安全性及有效性。方法采用随机分组的方法,将符合条件的60例高血压脑出血患者分为预防组和对照组。预防组32例,术后第1天至14天皮下连续注射低分子肝素0.2ml/d,同时穿戴弹力袜。对照组28例,未行抗凝措施和穿戴弹力袜。两组患者于术后1d,7d和14d分别行双下肢深静脉彩色超声多普勒检查,观察下肢深静脉血栓发生情况。术后1d和7d复查头颅CT,术后每天监测血小板计数和凝血功能。结果预防组32例无一例下肢深静脉血栓形成。对照组28例发生下肢深静脉血栓8例(28.6%),其中6例(21.4%)发生在瘫痪侧,7例(25.0%)发生在腘静脉以下,有症状者2例(7.1%),经溶栓或抗凝治疗好转;发生症状性肺栓塞1例(3.6%)。两组血小板计数和凝血功能差异无统计学意义(P>0.05),术后发生颅内出血各1例,经再次手术,病情均稳定。两组间术后再出血差异无统计学意义,而下肢深静脉血栓形成和肺栓塞发生率存在统计学差异(深静脉血栓28.6%vs0,P<0.01;肺栓塞3.6%vs0;P<0.05)。结论高血压脑出血患者在手术后皮下注射低剂量低分子肝素和使用弹力袜预防深静脉血栓形成是安全有效的,应该加以提倡。

Objective To assess the safety and availability of low dose of low-molecular-weight heparin combined with compression stockings for venous thromboembolism in patients with hypertensive intracerebral hemorrhage after operation. Methods Sixty patients of hypertensive intracerebral hemorrhage were randomly divided into 2 groups： prophylactic group（ n = 32 ）and control group （n = 28）. The patients in prophylactic group were injected hypodermically with low-molecular-weight heparin（0.2 ml/d）from day 1 to day 14 after operation, meantime, the patients wore compression stockings. While the patients in control group were given routine treatment. The deep vein of lower limbs in all patients were examined with colour doplar at day 1,7,14 after operation to observe venous thromboembolism. CT scanning of brain were reexamined at day 1 and 7, and blood platelet and clotting time were determined every day. Results No deep vein thrombosis occurred in prophylactic group, and intracerebral hemorrhage recurred in one case. In control group, deep vein thrombosis were found in 8 cases（28.6 % ）, and intracerebral hemorrhage recurred in 1 case, and pulmonary embolism in one case. Blood platelet and clotting time had no significant difference after operation between 2 groups. Conclusion Low dose of low-molecular-weight heparin and compression stockings are safe and available for deep venous thromboembolism in patients with hypertensive intracerebral hemorrhage as a prophylactic therapy.