低分子肝素预防高危深静脉置管的恶性肿瘤患者发生静脉血栓栓塞的效果研究

Effect of LMWH in VTE Prevention in High Risk Malignant Tumor Patients

目的探讨低分子肝素在预防高危的深静脉置管的恶性肿瘤患者发生静脉血栓栓塞(VTE)中的效果。方法选择Caprini模型VTE风险度评分≥5分的31例深静脉置管的恶性肿瘤患者为研究对象,在深静脉置管后进行预防性低分子肝素治疗,分析治疗后血栓发生的情况和各项观察指标(年龄、性别、病种等)与血栓发生的关系。结果 (1)预防性低分子肝素治疗后的血栓发生率为9.7%(3/31);(2)31例患者的各项观察指标不同水平的血栓发生率比较,差异均无统计学意义(P>0.05);(3)3例发生血栓的患者均来源于17例(54.8%)有2项或2项以上高危因素(VTE风险度评分、D-二聚体异常、激素治疗)的患者,余14例(45.2%)有0～1项高危因素,但无一例发生血栓,两组血栓发生率比较,差异无统计学意义(P=0.23);(4)低分子肝素预防用药后D-二聚体及血小板计数异常的患者由5例下降至1例。结论低分子肝素预防用药可以在一定程度上减少深静脉置管后高危患者发生VTE,但需进一步开展前瞻性随机对照研究。

Objective To explore the effect of low molecular weight heparin（LMWH）in preventing high risk malignant tumor patients from venous thromboembolism（VTE）.Methods Thirty-one malignant tumor patients evaluated as very high risk grade（≥5）of VTE by Caprini model were chosen as research objects.Prophylactic LMWH was conducted after deep venous catheter.The thrombosis incidence and observed indicators（age,gender,diseases,etc.）after treatment and their relationship were analyzed.Results After prophylactic LMWH,thrombosis incidence was 9.7%（3/31）.No significant difference was noted in thrombosis incidence between 31 patients with different levels of observed indicators（P0.05）.The 3 patients with thrombosis were among 17 patients（54.8%）having 2 or more risk factors,thrombosis did not occur in the other 14（45.2%）having 0~1 risk factor,the difference was not significant（P=0.23）.The number of patients with abnormal D-dimer and platelet count dropped from 5 to 1 after prevent LMWH.Conclusion LMWH can reduce VTE incidence of high risk patients after deep venous cartheter,but some further,prospective,randomized and comparative studies should be conducted.