不同剂量低分子肝素对胸心外科患者术后凝血功能的影响

Influence of Different Dose of Low Molecular Weight Heparin on Coagulation Function of Patients After Thoracic Surgery

目的探讨低分子肝素剂量对胸心外科患者术后凝血功能的影响。方法选择医院2010年5月至2015年5月收治的胸心外科患者90例,按随机数字表法将其分为对照组(予低分子肝素钙注射液1 000 U)和观察组(予低分子肝素钙注射液2 000 U),各45例。于术前和术后1,4,7 d检测和比较两组患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、D-二聚体(D-D)、血小板计数(PLT)水平,观察治疗期间不良反应发生情况。结果与术前相比,术后两组患者APTT显著缩短,PT明显延长(P<0.05);术后两组患者Fib和D-D水平均明显增高,其中观察组Fib增幅较小,D-D增幅较大(P<0.05);术后1 d两组患者PLT水平明显降低,而术后4,7 d两组患者PLT水平较术后1 d显著升高(P<0.05);治疗期间,两组患者均未出现明显不良反应。结论皮下注射高剂量低分子肝素能改善胸心外科患者术后的高凝状态,预防静脉血栓栓塞性疾病的发生,且不增加患者的出血风险,安全性较高,值得临床推广。

Objective To study the dose influence of low molecular weight heparin on coagulation function of patients after thoracic surgery. Methods 90 patients with thoracic surgery from May 2010 to May 2015 were divided into the control group （low molecular weight heparin injection,1 000 U） and the observation group （low molecular weight hepariu injection,2 000 U） according to the ran- dom number method,45 cases in each group. On pre-surgery,1 d post-surgery,4 d post-surgery,7 d post-surgery,the levels of ac- tivated partial thromboplastin time （APTT）, prothrombin time （PT）, fibrinogen （Fib）, D - dimer （D - D ） and platelet count （PLT） in the two groups were detected and compared. The adverse reactions during the treatment period in two groups were observed. Results Compared with the pre- surgery,the level of APTY was significantly decreased and the level of PT was significantly prolonged on post- surgery in two groups（P 〈 0.05）;compared with the pre-surgery,the levels of Fib and D-I） were obviously increased on post-surgery in two groups, however, the increasing degree of Fib was slighter and the increasing degree of D- D was larger in the observation group （P 〈 0. 05）;compared with the pre-surgery,the level of PLT was obviously reduced on 1 d post-surgery in two groups（ P 〈 0.05）; compared with I d post- surgery, the levels of PLT on 4 d and 7 d post- surgery were significantly increased in two groups （P 〈 0. 05）;there were no obvious adverse reactions in the treatment period in the two groups. Conclusion The subcutaneous injec- tion of high dose of low molecular weight heparin can improve the postoperative hypercoagulable state of patients after thoracic surgery and prevent the occurrence of venous thromboembolic disease without increasing the patients＇ bleeding risk. It is safe and is worthy of clinical promotion.