低分子肝素预防宫颈癌患者中心静脉导管相关血栓形成的临床研究

Effect of low molecular heparin on central venous catheter-related thrombosis in cervix caner patients

目的探讨低分子肝素预防宫颈癌患者中心静脉导管(CVC)相关深静脉血栓(DVT)形成的有效性及安全性。方法择期宫颈癌手术患者64例,行颈内静脉穿刺,随机均分为治疗组和对照组;术后2d,治疗组用0.5mg/d低分子肝素皮下注射连续治疗10d,对照组给予同等剂量的生理盐水。分别在治疗前1h(T0)、治疗后2d(T1)、10d(T2)、16d(T3)采集静脉血检测血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和栓溶二聚体浓度(D-dimmer);同时中心静脉导管置入处行血管彩色多普勒超声检查CVC相关DVT,观察是否有血栓形成和出血等不良反应。结果在治疗前后,两组患者Plt、PT、APTT差异无统计学意义。T1、T2时,对照组患者Fib和D-dimmer浓度明显高于治疗组和T0时(P<0.05);CVC相关DVT发生率明显高于治疗组(P<0.05)。两组患者均未发生出血等不良反应。结论低分子肝素0.5mg/d皮下注射10d预防宫颈癌患者CVC-related DVT有一定效果,且剂量安全。

Objective To investigate the effect and safety of low molecular heparin on central venous catheter （CVC）-related deep venous thrombosis （DVT） in cervix cancer patients. Methods Sixty four ASA Ⅱ or Ⅲ cervix cancer patients receiving internal jugular vein catheterization were randomly assigned into two groups： group treatment were treated with low molecular heparin, group control for sodium chloride. Serum samples were collected at baseline（T0 ）,2 d（T1 ）, 10 d （T2） and 16 d （Ta）of post-treatment for determination of blood platelets count （Plt）, prothrombin time （PT）, activated partial thromboplastin time（APTT）, Fibrinogen （Fib） and thrombus dissolving two dimer experiment（D-dimmer）. Information of central venous catheter-related deep venous thrombosis was observed by color Doppler ultrasonography and hemorrhage was also observed. Results There was no difference in Plt, PT and APTT in two groups. Fib and D-dimmer in group control were significantly higher at T1 and T2 than group treatment and To （P〈0.05）. Incidence of central venous catheter-related thrombosis was higher in group control than that in group treatment（P〈0.05）. Neither group had hemorrhage. Conclusion Low molecular heparin（0.5 mg/d） for ten days can prevent central venous catheter-related thrombosis safely in the cervix cancer patients.