低分子肝素预防普外科术后肺栓塞临床观察

Clinical Observation of Low Molecular Weight Heparin in Prevention of Acute Pulmonary Embolism in Patients Following General Surgery

目的:探讨低分子肝素用于普外科围手术期抗凝治疗预防肺栓塞的临床疗效。方法:1 146例普外手术病例根据术后抗凝与否分为两组。2005年1月～2008年8月,大、中型手术未行抗凝治疗组743例;2006年1月～2008年11月普外科手术后预防性抗凝组,肺栓塞风险分级≥中危病例403例。予低分子肝素5 000IU(中危病例142例)或10 000IU(高危261例)皮下注射预防性抗凝治疗。结果:未行抗凝治疗组发生急性肺栓塞7例,死亡5例,存活2例。术后低分子肝素预防性抗凝403例,并发出血3例(0.7%),无肺栓塞病例。低分子肝素预防性抗凝后PE发生率从0.9%降到0(P<0.05),肺栓塞死亡率差异无统计学意义。结论:对普外科手术后肺栓塞中、高危患者行预防性低分子肝素抗凝治疗,安全有效。

Objective： To study the perioperative anticoagulant therapy for patients in prevention of moderate or high risk of pulmonary embolism（PE） after general surgery. Method： 1146 patients who had undergone major general surgery were divided into a non-anticoagulant therapy group and an anticoagulant therapy group. There were 743 patients without the anticoagulant therapy during Jan. 2005 to Aug. 2008, a preventive anticoagulant therapy was performed on 403 patients who recived 5 000IU（ 142 patients at moderate risk of PE）or 10 000IU （261 patients at high risk of PE） low molecular weight heparin （LWMH） subcutaneous injection after major general surgery during Jan. 2006 to Nov. 2008. Result： Five cases died and 2 survived among 7 PE patients. Hemorrhage occurred in 3 out of 403 cases （0.7%） , but no PE occurred among 403 patients administered with the LWMH anticoagulant therapy. The incidence of PE in the patients reciving LWMH decreased from 0.9% to 0（P 〈0.05）. There was no significant difference in mortality. Conclusion： The preventive anticoagulant therapy is safe and effective for patients at moderate or high risk of PE after major surgery.