早期应用低分子肝素钙预防断流术后门静脉血栓形成的临床观察

Clinical observation of low-molecular heparin early preventing pylethrombosis after devascularization

目的观察门静脉高压症行断流术后早期应用低分子肝素钙对门静脉血栓形成的预防作用。方法回顾性分析我院2009年4月至2012年10月因门静脉高压症行脾切除、贲门周围血管离断术的58例患者的临床资料,分为低分子肝素钙治疗组(31例)和对照组(27例),治疗组于术后即给予低分子肝素钙预防性抗凝治疗,对照组术后不常规行预防性抗凝治疗,当血小板计数大于500×109/L或门静脉系统形成血栓时,再采用全身抗凝治疗,观察两组术后血小板、凝血功能变化及门静脉血栓发生率。结果治疗组血栓发生率低于对照组,差异有统计学意义(P<0.05),两组术后血小板、凝血功能差异无统计学意义(P>0.05)。结论早期应用低分子肝素钙抗凝治疗并不增加断流术术后出血风险,可以安全、有效地降低门静脉血栓形成的发生率。

Objective To observe the early precautionary effects of low-molecular heparin on pylethrombosis after peri-esophagogastric devascularization with splenectomy in portal hypertension. Methods 58 patients with portal hypertension ,undergoing peri-esophagogastric devascularization with splenectomy from April 2009 to October 2012 were retrospectively analyzed. They were divided into low-molecular heparin treatment group（ n = 31 ） and control group （ n = 27 ）. Treatment group was given low-molecular heparin after operation to prevent thrombosis prospectively, while control group was not given precautionary anticoagulation treatment unless the platelet count was over 500 x 109/L or pylethrombosis occurred. The change of platelet count, coagulation function and the incidence of pylethrombosis were compared between the two groups. Results The pyiethrombosis incidence of low-molecular heparin treatment group was lower than that of control group, and there was significant difference between the two groups （ P 〈 0. 05 ）. There was no significant difference in platelet count and coagulation function between the two groups（ P 〉 0.05 ）. Conclusion The early application of low-molecular heparin can prevent the formation of pylethrombosis effectively and safely, without the risk of postoperative bleeding.