妇科恶性肿瘤患者术后预防性抗血栓措施的效果

Effects of prophylactic antithrombotic measures in patients with gynecological malignancies after operation

目的探讨预防性抗血栓措施对妇科恶性肿瘤患者术后凝血功能指标的影响。方法回顾性分析2009年1月~2014年1月于北京肿瘤医院放射科行宫颈癌、子宫内膜癌、卵巢癌首次根治术的100例患者的临床资料,根据术前是否给予预防性抗血栓治疗,将患者分为对照组和观察组,每组各50例。观察组术后第1天开始预防性应用低分子肝素5000 U/d×7 d,对照组不予预防性抗血栓治疗。分析并比较两组患者术前3 d及术后2周的凝血功能指标、血小板活化、凝血抗凝血指标和纤溶指标情况。结果治疗后,观察组患者Fbg、D-D[（2.3±1.9）g/L、（0.35±0.19）μg/mL]明显低于治疗前[（4.7±2.1）g/L、（0.42±0.2）μg/mL]及对照组治疗后[（4.4±2.2）g/L、（0.39±0.16）μg/mL],差异均有统计学意义（P〈0.05）;治疗后,观察组患者TF、TAT、TFPI、TpP、AT[（36.5±2.5）ng/L、（3.1±1.7）μg/L、（78.0±18.5）μg/L、（4.7±2.2）μg/m、（90.0±12.5）%]与治疗前[（43.1±1.9）ng/L、（5.5±1.4）μg/L、（67.7±21.3）μg/L、（6.7±1.9）μg/m、（78.1±10.7）%]及对照组治疗后[（40.7±2.2）ng/L、（4.2±1.3）μg/L、（70.5±20.0）μg/L、（5.2±2.1）μg/m、（86.6±8.7）%]比较,差异均有统计学意义（P〈0.05）;观察组深静脉血栓发生率为2.0%,明显低于对照组（12.0%）,两组比较差异有统计学意义（χ2=4.926,P〈0.05）。结论妇科恶性肿瘤患者术后血液黏滞度普遍升高,预防性应用低分子肝素能有效降低血液黏滞度、预防静脉血栓的发生。

Objective To study the preventive antithrombotic measures for postoperative blood coagulation function in patients with gynecological malignant tumor index. Methods The clinical data of 100 cases of patients with cervical cancer, endometrial carcinoma or ovarian cancer radical operation for the first time from January 2009 to January 2014 in Beijing Cancer Hospital were retrospectively analyzed. According to whether give preoperative preventive antithrombotic treatment, the patients were divided into control group and observation group, with 50 cases in each group. 1 day after the operation the observation group were given the low molecular heparin 5000 U per day, for 7 days; the control group were not given the preventive antithrombotie measures. The blood coagulation function indexes, platelet activation and blood coagulation anticoagulant indexes, and the fibrinolytic indexes of two groups in 3 days before operation and 2 weeks after operation were detected and compared. Results After treatment, the Fbg and D-D of patients in the obser- vation group [（2.3±1.9） g/L, （0.35±0.19） μg/mL] were obviously lower than those before treatment [（4.7±2.1） g/L, （0.42± 0.2） μg/mL] and those of the control group after treatment [（4.4±2.2） g/L, （0.39±0.16） μg/mL], the differences were sta- tistically significant （/9 〈 0.05）; TAT, TFPI, TF, TpP and AT of patients in the observation group after treatment were （36.5±2.5） ng/L, （3.1±1.7）μg/L, （78.0±18.5） μg/L, （4.7±2.2） μg/m, （90.0±12.5）% respectively, compared with before treatment [（43.1±1.9） ng/L, （5.5±1.4） μg/L, （67.7±21.3） μg/L, （6.7±1.9） μg/m, （78.1±10.7）%] and the control group after treatment [（40.7±2.2） ng/L, （4.2±1.3）μg/L, （70.5±20.0） μg/L, （5.2±2.1） μg/m, （86.6±8.7）%], the differences were statis- tically significant （P 〈 0.05）; the incidence of deep vein thrombosis in the observation group was 2.0%, was obvious lower than that of the control group （12.0%）, the difference of two groups was statistically significant （X 2=4.926, P 〈 0.05）. Conclusion The patients with gynecology malignant tumor postoperative blood viscosity rise generally, the prophylactic use of low molecular heparin can effectively reduce the blood viscosity, prevent the happening of the vein thrombosis.