低分子肝素用于预防妇科手术血栓形成的临床研究

Clinical research on prophylactic thrombosis for patients undergoing gynecological surgery with low molecular weight heparin

目的:探讨对有高危因素的妇科手术患者进行预防性血栓治疗的临床意义。方法:将2007年10月～2009年10月在我院住院的80例有高危因素的妇科手术患者随机分为低分子肝素(LMWH)组(40例)和对照组(40例,无预防措施),对下肢深静脉血栓(LDVT)的预防效果及安全性进行比较,并分析影响LDVT预防效果的相关因素。结果:LMWH组LDVT的患肢发生率为1.25%(1/80),对照组为17.50%(14/80),LMWH组均明显低于对照组(P<0.05);对照组发现LDVT的时间以术后3～4d最多,为10条下肢;LMWH组仅1条下肢发生LDVT,于术后5d时发现。LMWH组术后3～4d时LDVT的发生率为0,对照组为71.43%(10/14),LMWH组明显低于对照组(P<0.05)。LMWH组仅1例术后阴道残端出现少量出血,无手术切口出血及出血倾向发生。高龄、开腹手术及恶件肿瘤为影响LDVT预防效果的相关因素(P<0.05)。结论:妇科手术后对有高危因素的患者预防性血栓治疗可以明显减少并延迟其术后LDVT的发生;高龄、开腹手术及恶性肿瘤为影响LDVT预防效果的重要因素。

Objective： To explore the clinical significance of prophylactic thrombosis for patients undergoing gynecological surgeries with high risk factors. Methods： 80 patients underwent gynecological surgery with high risk factors from October 2007 to October 2009 in our hospital were divided into low molecular weight heparin group （LMWH group, 40 cases） and control group （40 cases, no preventive measure）, then the preventive measure and safety for the lower extremity deep venous thrombosis （LDVT） were compared, the related factors of affecting the preventive efficacy of LDVT. Results： The morbidity of LDVT on lower extremity was 1.25% （1/80） in LMWH group and 17.50% （14/80） in control group, obviously reduced in LMWH group than that in control group （P0.05）. After surgery in 3-4 days, 10 in control group; 1 in LMWH group after 5 days. The rate of LMWH group was 0 in 3-4 day, and 71.43% （10/14） in control group, there was significantly reduced in LMWH group than that in control group （P0.05）. Only 1 case in LMWH group presented small quantity bleed in vagina remnant, while no incision bleeding and bleeding tendency. Elder age, abdominal surgeries and malignant tumor were as the independent factors to affect preventive treatment of thrombosis （P0.05）. Conclusion： LDVT in patients underwent gynecological surgeries with high risk factors could be obviously reduced and delayed by preventive treatment, while be affected by the factors of elder age, abdominal surgeries and malignant tumor.