低分子肝素在中老年人腹部肿瘤围手术期的应用研究

The application of Fragmin at the abdominal tumor perioperative care in the elderly

目的探讨小剂量低分子肝素(法安明)对腹部肿瘤围手术期患者凝血试验的变化及出血的影响。方法 90例行腹部肿瘤择期手术的患者随机分为两组,即法安明组45例,空白对照组45例。法安明组于术前2h、术后1h、术后第6天各给予法安明2500U一次。对照组未予以任何抗凝药物处理。所选参与者的年龄均在50岁以上。两组的年龄、性别、术前凝血酶原时间(PT)、肿瘤类型均具可比性。分别测定患者术前及术后血浆中的抗Ⅹa活性,并记录患者术中及术后的出血情况。结果法安明组术前2h、术后1h、术后第6天的抗Ⅹa活性分别为0.023IU/ml、0.225IU/ml、0.271IU/ml,术后抗Ⅹa活性明显高于术前抗Ⅹa活性(均P<0.05)。而对照组术前相应时间点的抗Ⅹa活性分别为0.017IU/ml、0.003IU/ml、0.014IU/ml,手术前后抗Ⅹa活性均无明显差异(P>0.05)。两组之间术前抗Ⅹa活性无明显差异(P>0.05)。法安明组术中弥漫性出血量明显高于对照组(P<0.05),术中和术后的外科出血量与对照组均无明显差异(P>0.05),但术后伤口出血量明显高于对照组(P<0.05)。结论小剂量的法安明(2500U)能明显增加抗Ⅹa活性,从而达到预防腹部肿瘤术后深静脉血栓形成的目的,但术前给药能明显增加术中弥漫性出血以及术后伤口出血,不推荐术前预防性应用法安明。

Objective To evaluate the change of the blood coagulation experiment and bleeding caused by low-dose Fragmin in the patient of abdominal tumor periopertive care.Methods In a randomized trial of 90 patients(45 patients were in the Fragmin group and 45 in the blank contrast group)undergoing elective abdominal tumor surgery.Fragmin was given in a dose of 2500 U two hours before surgery,the first day and 6th days after operation in the Fragmin group,and the blank group do not get any anticoagulant drugs.All patients were over 50 years old.Comparability between groups was found in age,sex,PT value before operation,type of tumor.The anti-Ⅹa activity in human plasma was measured for all pre- and post-operative patients respectively.Intra- and post-operative bleedings were recorded.Results The anti-Xa activity of before operation,the first and the 6th hours postoperative day was 0.023 IU/ml,0.225 IU/ml,0.271 IU/ml respectively in the Fragmin group,and the postoperative were significantly higher than the before(P<0.05).The anti-Xa activity of before operation,the first and the 6th hours postoperative day was 0.017 IU/ml,0.003 IU/ml,0.014 IU/ml respectively in the blank contrast group,and there was no significantly difference among them(P>0.05).There was no significantly difference between the two groups on preoperative anti-Xa activity(P>0.05).The amount of intra-operative disseminated bleeding in Fragmin group was significantly higher than that in the blank contrast group(P<0.05).There was no difference between the two group on the amount of surgery bleeding and postoperative bleeding(P>0.05)but the amount of postoperative wound bleeding was significantly higher than the contrast group(P<0.05).Conclusions Low-dose Fragmin(2500 U)can enhance the anti-Xa activity,with the result that prevents abdominal tumor post-surgrical deep vein thrombosis.But Fragmin given in before surgery can significantly enhance disseminated bleeding of introperative wound area and postoperative wound bleeding,so Fragmin should not given in prophylaxis before surgery.