直肠癌术后应用低分子肝素预防静脉血栓性疾病的价值

Effects of low molecular weight heparin as prophylaxis against venous thromboembolism after rectalcancer surgery

目的评价直肠癌术后早期应用低分子肝素预防静脉血栓性疾病的临床价值。方法回顾性分析2008年10月至2010年10月天津市人民医院收治的120例行直肠癌根治手术患者的临床资料，根据是否应用低分子肝素将患者分为试验组（50例）和对照组（70例）。试验组患者术后8-12h给予皮下注射低分子肝素钙0.4ml（4100U），以后每日注射1次，直至下床活动为止。对照组未应用低分子肝素治疗。比较两组患者发生静脉血栓性疾病（VTE）及术后出血等情况，并对VTE患者进行危险因素分析。计量资料采用t检验，率的比较采用，检验或Fisher确切概率法，影响术后VTE形成因素采用Logistic回归分析。结果试验组和对照组患者术后VTE发生率分别为2．0％（1／50）和14．3％（10／70），两组比较，差异有统计学意义（X2=3．915，P〈0．05）；试验组和对照组患者术后出血发生率分别为6．0％（3／50）和2．9％（2／70），两组比较，差异无统计学意义（X2=0．149，P〉0．05）。下肢静脉曲张、既往心肺疾患及用药史、肥胖和年龄〉65岁是导致直肠癌术后易患VTE的独立危险因素（OR=2．3，2．5，1．4，2．1，P〈0．05）。随着危险因素的不断累加，VTE患病数量呈现上升的趋势。结论直肠癌手术伴发易患VTE多种危险因素的患者术后早期应用低分子肝素预防VTE安全且疗效肯定。

Objective To investigate the clinical value of low molecular weight heparin （LMWH） as prophylaxis against venous thromboembolism after rectal cancer surgery. Methods The clinical data of 120 patients who received rectal cancer surgery at the Tianjin People＇s Hospital from October 2008 to October 2010 were retrospectively analyzed. All patients were divided into the test group （50 patients） and the control group （70 patients）. Patients in the test group received subcutaneous injection of 0.4 ml of LMWH （4100 U） at 8-12 hours after operation, and then once a day thereafter until mobilization. LMWH was not given to patients in the control group. Patients in the 2 groups who experienced venous thromboembolism （VTE） and postoperative bleeding were recorded and compared. The clinical data of patients with VTE were proceeded with risk factors analysis. All data were analyzed using the t test, chi-square test or by calculating Fisher exact probability. All factors influencing VTE formation were analyzed using Logistic regression analysis. Results The incidences of VTE in the test group and the control group were 2.0% （1/50） and 14.3% （10/70）, respectively, with a significant difference between the 2 groups （X2= 3. 915, P 〈 0.05 ）. The incidences of postoperative blood loss in the test group and the control group were 6.0% （3/50） and 2.9% （2/70） , respectively, with no significant difference between the 2 groups （X2= 0. 149, P 〉 0.05 ）. Varicose veins of lower limbs, previous cardiopulmonary diseases, obesity and age 〉 65 years were the independent risk factors of VTE （ OR = 2.3, 2. 5, 1.4, 2. 1, P 〈 0.05 ）. The number of patients with VTE increased as the increase of the risk factors. Conclusion Early injection of LMWH after rectal cancer surgery is safe and effective in preventing VTE.