低分子肝素预防合并糖尿病的腹腔镜手术患者围手术期静脉血栓形成的效果

Effect of low molecular weight heparin on preventing inferior vena DVT in diabetic patients after laparoscopic surgery

目的探讨合并糖尿病的腹腔镜手术患者应用低分子肝素(LMWH)预防围手术期深静脉血栓(DVT)的效果。方法将100例2型糖尿病腹腔镜手术患者随机分为2组,非LMWH组常规手术,LMWH组术后腹壁皮下注射低分子肝素。于手术前后取患者空腹静脉血,测定血小板功能(PLT、MPV、PCT、CD62p、v WF),凝血-纤溶功能(PT、APTT、Fib、AT-Ⅲ、t-PA、PAI-1)及血液流变学指标(全血粘度、血浆粘度、HCT、RBCAI);并以50例非糖尿病腹腔镜手术者为对照组行对比分析。结果非LMWH组下腔DVT发生率高于LMWH组和对照组(P<0.05),LMWH组与对照组差异无统计学意义(P>0.05)。术前,非LMWH组和LMWH组之间PLT、MPV、PCT、CD62p、v WF、全血粘度、血浆粘度、HCT、RBCAI、Fib、AT-Ⅲ、PAI-1、t-PA水平差异均无统计学意义(P>0.05),且AT-Ⅲ与t-PA低于对照组,其他指标高于对照组(P<0.05)。术后3组AT-Ⅲ与t-PA降低,且非LMWH组低于LMWH组,LMWH组低于对照组;其他各项指标升高,且非LMWH组高于LMWH组,LMWH组高于对照组,其组间差异均有统计学意义(P<0.05)。结论糖尿病患者血小板、血液流变学及凝血-纤溶参数异于常人,腹腔镜术后DVT发生率高,低分子肝素可起到预防效果,具有较高的应用价值。

Objective To explore the effect of low molecular weight heparin （LMWH） on preventing inferior vena deep venous thrombosis（DVT） in diabetic patients after laparoseopic surgery. Methods Total 100 patients with type 2 diabe- tes which were prepared for laparoscopic surgery were divided into 2 groups randomly. The non-LMWH group was given conventional surgery,while the LMWH group was injected abdominal subcutaneous LMWH. The fasting blood of patients was extracted both before and after surgery, and the platelet functions （ PLT, MPV, PCT, CD62p, vWF）, coagulation-fi- brinolytie function（ PT, APTY, Fib, AT-Ill, t-PA, PAI-1 ） and hemorheology（ whole blood viscosity, plasma viscosity, HCT, RBCAI） were detected. At the same time,50 patients without diabetes which were prepared for laparoscopic surgery were selected as the control group for comparative study. Results The DVT incidence of non-LMWH group was higher than that of the LMWH group and the control group （ P 〈 0.05 ）, while there was no significant difference between LMWH group and the control group（ P 〉 0.05 ）. Before surgery, there was no significant difference in PLT, MPV, PCT, CD62p, vWF,whole blood viscosity, plasma viscosity, HCT, RBCAI, Fib, AT-Ⅲ, PAI-1 or t-PA level between the LMWH group and non-LMWH group（ P 〉 0. 05 ） ;and AT-Ⅲ and t-PA were both lower than those of the control group, the others were all higher than those of the control group （ P 〈 0.05 ）. After surgery, the AT-Ⅲ and t-PA level of all the groups decreased, and the non-LMWH group was lower than the LMWH group, the LMWH group was lower than the control group; the others of all the groups increased, and the non-LMWH group was higher than the LMWH group, the LMWH group was higher than the control group, all the difference between groups had statistical significance （ P 〈 0.05 ）. Conclusion The platelet function,coagulation-fibfinolytic function and hemorheology of patients with diabetes was different from normal individu- als,which lead to high incidence of postoperative DVT after laparoscopic surgery, and LMWH can make a protective effect, which has higher application value.