低分子量肝素对胸外科高龄患者术后凝血功能影响的临床研究

Clinical study of influence of low molecular weight heparin on coagulation function in elderly patients after thoracic surgery

目的对比研究胸外科高龄患者术后凝血功能变化及低分子量肝素的临床干预效果。方法选取2007年9月至2009年12月接受开胸手术的96例高龄患者，用随机数字表法分为对照组54例和试验组42例（术后第，1～7天皮下注射低分子量肝素）。观察两组患者术前和术后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血小板（Plt）、D-二聚体（D-D）、纤维蛋白原（Fib）以及抗一Xa活性等凝血功能指标的变化及临床表现，同时观察糖尿病对手术前后凝血功能指标的影响。结果试验组和对照组术前的各项凝血功能指标比较差异无统计学意义（P〉0．05）。术后各时间点对照组P，r延长，Fib、D-D升高，与术前比较差异有统计学意义（P〈0．05）。术后各时间点对照组的Fib、D-D较试验组升高（P〈0．05）。试验组术后各时间点抗-Xa活性较术前逐渐升高（P〈0．05），与对照组比较差异有统计学意义（P〈0．05）。糖尿病对术后凝血功能的变化无明显影响。对照组出现1例肺血栓栓塞症，试验组无一例出现静脉血栓栓塞症及出血等不良反应。结论胸外科高龄患者术后血液处于高凝状态，容易出现静脉血栓栓塞症，术后早期给予适量低分子量肝素预防性治疗，有利于改善高凝状态并有较好的安全性。

Objective To compare the changes of blood coagulation system and the clinical interventional effect of low molecular weight heparin （LMWH） in elderly patients who had received thoracic surgery. Methods Ninety-six thoracic surgery patients （age ≥ 70 years） were divided into control group （54 cases） and experimental group （42 cases ）（postoperative 1-7 days, subcutaneous injection with LMWH ） from September 2007 to December 2009 by random digits table. Observed perioperative changes in prothrombin time （PT）,activated partial thromboplastin time （APl3＂）,platelet （Plt）,D-dimer （D-D）, fibrinogen （Fib）, anti- X a activity, and clinical performances. Also observed the influence of diabetes meUitus of surgery coagulation function. Results The preoperative indexes of Coagulation function were no significant （P 〉 0.05 ）. In control group PT prolonged, Fib and D-D increased, the differences between preoperative and postoperative each time were significant （P 〈 0.05 ）. Fib and D-D in control group increased than those in experimental group postoperative each time （P 〈 0.05 ）. In experimental group anti- X a activity increased postoperative each time （P 〈 0.05 ）, compared with control group was also significant （P 〈 0.05 ）. Diabetes mellitus had no significant influence on coagulation function. One patient appeared pulmonary thromboembolism in control group,and no one appeared venous thromboembolism and bleeding adverse reactions in experimental group. Conclusion Thoracic surgery in elderly patients have high blood coagulation state, prone to venous thromboembolism, LMWH given early postoperative prophylactic treatment is beneficial to improve the hypercoagulable state and have better security.