达肝素钠预防大隐静脉曲张术后下肢深静脉血栓及危险因素分析

Dalteparin sodium in preventing low extremity deep venous thrombosis after operation of great saphenous vein varicose and analysis on risk factors

目的探讨大隐静脉曲张术后预防性使用达肝素钠的安全性和有效性,并分析引起下肢深静脉血栓形成(LDVT)的危险因素。方法回顾性分析640例大隐静脉曲张患者的临床资料,其中2011年9月至2012年12月入院的320例大隐静脉曲张患者术后预防性应用达肝素钠治疗(治疗组),2009年7月至2011年8月入院的320例大隐静脉曲张患者术后不采用达肝素钠治疗(对照组)。结果治疗组发生LDVT 1例,对照组发生LDVT 5例,两组比较,差异有统计学意义(P<0.05);治疗组应用达肝素钠治疗5 d后有关凝血功能指标及血小板计数与术前比较,差异无统计学意义(P>0.05)。两组发生LDVT的患者年龄均大于62岁;发生于双侧肢体5例(治疗组1例,对照组4例),单侧肢体1例;CEAP分级中Ⅵ级4例(治疗组1例,对照组3例),Ⅴ级2例;治疗组1例伴高血压、高血脂和糖尿病,对照组伴高血脂和高血压3例,糖尿病并高血压1例,糖尿病1例。结论患者年龄、高血脂、糖尿病和(或)高血压、CEAP分级是大隐静脉曲张术后诱发LDVT的危险因素,术后预防性使用达肝素钠安全、有效,值得临床广泛推广应用。

Objective To investigate the safety and effectiveness of prophylactic administration of dalteparin sodium after the operation of great saphenous vein varicose and to analysze the risk factors causing low extremity deep venous thrombosis（LDVT）.Methods The clinical data of 640 patients with great saphenous vein varicose were retrospectively analyzed.Among them,320 cases received preventive subcutaneous injection of dalteparin sodium（treatment group） from September 2011 to December 2012 and the other 320 cases did not receive subcutaneous injection of dalteparin sodium from July 2009 to August 2011（control group）.Results LDVT occurred in 1 case in the LDVT group and 5 cases in the control group,there was statistical difference between them（P0.05）;the relative coagulation function indexes and platelet count on 5 d after dalteparin sodiumtreat ment in the treatment group had no statistical differences compared with before treatment（P0.05）.LDVT cases in the two groups aged over 62 years old,5 cases were bilateral limbs（1 case in the treatment group and 4 cases in the control group）,1 case was u nilateral limb;in the CEAP clssification,4 cases were class Ⅵ（1 case in the treatment group and 3 cases in the control group）,class Ⅴ was 2 cases;1 case in the treatment group was complicated with hypertension,hyperlipidemia and diabetes,while in the control group,3 cases were complicated with hypertension,hyperlipidemia,1 case was complicated with diabetes and hypertension and 1 case was with diabetes.Conclusion The age,hyperlipidemic diabetes and（or） hypertension,CEAP claasification are the risk factors inducing LDVT after the operation of great saphenous vein varicose.The postoperative prophylactic administration of dalteparin sodium is safe and effective and deserves to be widely promoted in clinic.