低分子肝素预防妇科肿瘤术后下肢深静脉血栓形成的研究

Study on Low Molecular Weight Heparin for Preventing the Deep Vein Thrombosis of Lower Ex- tremities after Gynecological Cancer Surgery

【目的】探讨妇科肿瘤术后早期应用低分子肝素预防下肢深静脉血栓（DVT）的临床疗效。【方法】89例妇科肿瘤手术患者随机分威肝素治疗组47例与对照组42例，治疗组术后12h、24h、48h均皮下注射低分子肝素5000μ，对照组不采用预防性用药。两组均记录盆腔引流量及拔除引流管时间，检测并比较术前、术后d3、d7双下肢静脉血管和血流情况，术前和术后d1、d2、d5、d7血小板、凝血功能、D－二聚体（D-D）等指标。【结果】治疗组和对照组相比，术后盆腔引流量和拔管时间比较无显著性差异（P〉0．05），术前与术后血小板、凝血功能比较无显著性差异（P〉0．05）；治疗组D-D术后d1达到高峰，对照组D-D在术后d3达到高峰，且高值持续时间大于治疗组。血管彩超结果：对照组术后d7有7例患者下肢静脉血栓形成；治疗组术后d7有2例下肢静脉微小血栓。两组病人均未发生肺栓塞。【结论】低分子肝素可降低妇科肿瘤术后下肢深静脉血栓发生率，且不会增加术后出血危险。

[Objective]To explore the clinical efficacy of low molecular weight heparin（LMWH） used in early period after gynecological cancer surgery for preventing deep vein thrombosis（DVT） of lower extremities. [Methods]Totally 89 patients undergoing gynecological cancer surgery were randomly divided into LMWH treatment group（ n =47） and control group（ n =42）. The treatment group was injected subcutaneously with LMWH 5000/1 at 12h, 24h and 48h after operation. The control group was not given prophylactic medication. The volume of pelvic drainage and extubation time in two groups were recorded. The blood flow of both lower extremities at d3 and dr before and after operation, platelet, coagulation, D-dimer and other indicators at d1 , d3, d5 and d7 before and after operation were measured and compared. [Results]There was no significant difference in postoperative pelvic drainage volume and extubation time between treatment group and control group（ P 〉0.05）. There was no significant difference in platelet and coagulation between before and after operation（ P 〉0. 05）. D-dimer in treatment group at dl after operation reached the peak, and that in control group at d3 after operation reached the peak. The duration of high value of D-dimer in treatment group was longer than that in control group. Vascular color ultra sound showed that DVT of lower extremities at d7 after operation was found in 7 cases ia control group and small vein thrombosis of lower extremitiesat d7 after operation was found in treatment group. No pulmonary embolism occurred in patients of two groups. [Conclusion] LMWH can effectively reduce the incidence of DVP of lower extremities after gynecological cancer surgery, and will not increase the risk of postoperative bleeding.