妇科盆腔术后下肢深静脉血栓预防方法的研究分析

Research and analysis on prevention methods of lower extremity deep vein thrombosis after gynecological pelvic operation

目的分析妇科具有血栓中、高危因素患者盆腔术后药物与机械方法预防下肢深静脉血栓形成(LEDVT)的效果及应用抗血栓梯度弹力袜(GCS)、间歇充气加压泵装置(IPC)、低分子肝素(LMWH)预防LEDVT的有效性。方法选取2014年6月-2016年5月该院收治的具有血栓中、高危因素并拟行妇科盆腔手术的患者90例,按照不同预防血栓的方法随机分为A组(GCS组)、B组(GCS+LMWH组)、C组(GCS+IPC组),每组30例,术前、术后留取血标本,进行双下肢静脉、髂静脉彩超检查,分析3组预防措施对血栓发生率和实验室检查的影响,评价各方法的效果。结果患者下肢深静脉血栓的发生率A组为13.33%,B组为0.00%,两组差异有统计学意义(P<0.05);C组为6.67%低于A组,但两组差异无统计学意义(P>0.05);B组与C组比较,差异无统计学意义(P>0.05)。3组患者D-二聚体术前差异无统计学意义(P>0.05),而术后差异有统计学意义(P<0.05);术后LEDVT患者D-二聚体升高显著。B组患者手术前后血常规、凝血功能差异有统计学意义(P<0.05)。结论妇科术后应用两种方法联合预防优于单独应用弹力袜,其中弹力袜联合低分子肝素预防LEDVT的效果更明显。D-二聚体在诊断术后LEDVT时具有高敏感性和低特异性的特点,可联合下肢静脉超声用于术后LEDVT的筛查。

Objective To analyze the effects of medication and mechanical methods in preventing postoperative lower extremity deep vein thrombosis（ LEDVT） in patients with moderate and high risk factors of thrombosis in Department of Gynaecology,explore the effectiveness of anti-thrombotic graduated compression stocking（ GCS）,intermittent pneumatic compression（ IPC） and low molecular weight heparin（ LMWH） in preventing LEDVT.Methods Ninety patients with moderate and high risk factors of thrombosis preparing for gynecologic pelvic surgery in the hospital from June 2014 to May 2016 were selected,then they were randomly divided into group A（ GCS group）,group B（ GCS＋LMWH group） and group C（ GCS＋IPC group）,30 patients in each group.Preoperative and postoperative blood specimens were obtained,bilateral lower limbs veins and iliac vein ultrasonography were conducted.The effects of prevention measures used in the three groups on incidence rates of thrombosis and laboratory tests were analyzed,the effects of different methods were evaluated.Results The incidence rates of LEDVT in group A and group B were 13.33% and 0.00%,respectively,there was statistically significant difference between the two groups（ P〈0.05）.The incidence rate of LEDVT in group C was 6.67%,which was lower than that in group A,but there was no statistically significant difference between the two groups（ P〉0.05）.There was no statistically significant difference between group B and group C（ P〉0.05）.Before surgery,there was no statistically significant difference in D-dimer level among the three groups（ P〉0.05）;after surgery,there was statistically significant difference（ P〈0.05）.After surgery,D-dimer level in LEDVT patients increased significantly.In group B,there were statistically significant differences in blood routine examination and blood coagulation function between before and after surgery（ P〈0.05）.Conclusion The prevention effect of joint application of two methods in preventing postoperative LEDVT is better than that of single application of GCS,the prevention effect of GCS combined with LMWH is more obvious.D-dimer has the characteristics of high sensitivity and low specificity in diagnosis of postoperative LEDVT,D-dimer combined with lower limb venous ultrasonography can be used for postoperative LEDVT screening.