超声监测胸外科肿瘤术后低分子肝素预防深静脉血栓效果的观察

Color Doppler ultrasonography in monitoring thrombosis of lower limb deep vein after malignantthoracic tumor surgery

对30例胸外科恶性肿瘤手术患者于术后24h开始每12小时腹壁皮下注射低分子肝素0．3ml，连续3d，行超声检查观察深静脉血栓形成（DVT）情况（研究组），并以30例未应用肝素者为对照。术后检出DVT7例，其中研究组1例（3％），发生率显著低于对照组的20％（6例）（P〈0．05），血栓最早于术后1d检出，单纯小腿肌间静脉血栓6例，胫后静脉血栓1例。与对照组比较，研究组术后1d时纤维蛋白原（FIB）、D-二聚体无显著变化（P〉0．05），术后3d时FIB、D-二聚体显著降低（P〈0．05）。低分子肝素显著降低术后高凝状态，减少下肢DVT发生；超声可作为术后早期监测无痒状小腿DVT及预防措旆效果的首诜方法。

Sixty patients underwent surgery for malignant thoracic tumor were evenly randomized into control group （group A） and treatment group （group B）. 0. 3 ml low-molecular-weight heparin was injected per 12 h for 3 d in group B from 24 h after surgery. Bilateral venous sonography of lower extremities were performed before and dl, d3 after operation. Blood coagulation marks PLT, PT, APTT, Fibrinogen （FIB） and D-dimer were determined at the same time. Diagnosis of calf vein thrombosis after surgery was confirmed by color Doppler sonography in 7 patients： 1 in group B（3%） and 6 in group A（20%） （P〈0.05）. Thrombosis at calf intermuscular vein was found in 6 patients and thrombosis at posterior tibial vein in 1 patient. FIB and D-dimer had no significant difference on the dl （ P 〉 0. 05 ） between two groups, butsignificantly lower on the d3 after surge group B than that ill group A （ P 〈 O. 05 ）. eight heparin reduced blood hypereoagulation state and thromlosis. Color Doppler sonography can be a va]uable method deteeting asymplomatit deep vein thrombosis in the early stage after surgery and monitoring the efficacy of thrombosis prevention.