华法林与低分子肝素联合应用预防门脉高压脾切断流术后门静脉血栓形成的临床治疗分析

Clinical treatment analysis of early use of warfarin combined with low molecular weight heparin in patients with portal hypertension after splenectomy

目的 探索门静脉高压症患者脾切断流术后早期应用华法林联合低分子肝素抗凝对门静脉血栓（PVT）的治疗效果.方法 选择河南省人民医院肝胆胰腺外科于2012年1月至2013年5月治疗的96例门静脉高压行脾切断流术患者,其中术后口服阿司匹林预防血栓的42例患者作为对照组,术后联合应用华法林与低分子肝素抗凝的54例患者作为联合治疗组,术后监测凝血酶原时间（PT）及血小板（PLT）数量的变化,彩超检测门静脉血流速度,并于术后1周、2周及1个月检查彩超了解门静脉血栓情况.结果 口服阿司匹林的对照组术后不同时期PVT形成有6例,发生率为14.29％,其中脾静脉残端血栓发生3例,肠系膜上静脉血栓2例,门静脉主干血栓1例;联合治疗组发生PVT共有1例脾静脉残端血栓,发生率为1.85％,两组比较差异有统计学意义（P ＜0.05）.结论 门脉高压患者脾切断流术后应用华法林抑制凝血酶原及其他凝血因子生成,并早期联合低分子肝素抗凝能有效预防门静脉系统血栓的形成。

Objective To analyze the clinical effects of early application of warfarin and low molecular weight heparin on patients with portal hypertension after splenectomy anticoagulation in the prevention of portal vein thrombosis （PVT）.Methods Ninety-six patients with portal hypertension after splenectomy from January 2012 to May 2013 were selected,42 patients treated with oral aspirin for the prevention of thrombosis were selected as the control group,and 54 patients treated with warfarin and low molecular weight heparin anticoagulation after operation were selected as the combined treatment group.The changes of prothrombin time（PT）,platelet（PLT） were monitored,the portal vein blood flow velocity was tested by color Doppler ultrasound.The portal vein thrombosis were checked by color Doppler ultrasound 1 week,2 weeks and 1 month postoperatively.Results Six patients formed PVT in different postoperative periods in the control group,the incidence was 14.29% ; The incidence of treatment group was 1.85%,and had 1 case of PVT.There was significant difference between the two groups （P 〈 0.05）.Conclusions Early use of warfarin combined with low molecular weight heparin in patients with portal hypertension after splenectomy is effective on preventing the formation of portal vein thrombosis.