尿素激酶联合低分子肝素防治妇科肿瘤并发下肢静脉血栓的临床观察

Urokinase combined with low molecular weight heparin in the prevention and treatment of gynecological tumors complicated with lower extremities venous thrombosis

目的探讨尿素激酶联合低分子肝素防治妇科肿瘤并发下肢静脉血栓的临床效果。方法选取2014年1月至2016年12月间湖南省肿瘤医院收治的100例行腹腔镜妇科肿瘤手术患者,采用随机数表法分为观察组与对照组,每组50例。对照组患者采用低分子肝素抗凝针治疗,观察组在对照组基础上加用尿素激酶治疗。比较两组患者治疗前后下肢血流、血清抗凝血因子Xa活性(抗-FXa)、抗凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血清纤维蛋白原及D-二聚体含量变化,患者住院期间并发症及不良反应情况。结果对照组患者住院期间发生下肢静脉血栓1例,观察组患者无;术后治疗10天期间,两组患者均未出现并发症及不良反应。观察组患者下肢周径和下肢血流显著优于对照组,血清纤维蛋白原和D-二聚体含量显著低于对照组,抗-FXa、PT及APTT值显著高于对照组,组间差异均有统计学意义(均P<0.01)。结论小分子肝素和尿素激酶在妇科肿瘤术后下肢静脉血栓防治中联用,疗效显著,安全性高,值得推广。

Objective To investigate the clinical efficacy of urokinase combined with low molecular weight heparin in the prevention and treatment of lower extremity venous thrombosis. Methods One hun- dred patients with gynecological tumors undergoing laparoscopic surgery at Hunan Provincial Tumor Hospital were selected from January 2014 to December 2016 as the study subjects. The patients were randomly divid- ed into an observation group and a control group with 50 patients in each group. The control group was trea- ted with low molecular weight heparin anticoagulant needle. On the basis of the control group, the observa- tion group was treated with urokinase. The changes of lower limb blood flow, the serum anticoagulant factor Xa activity （anti-FXa）, prothrombin time （PT）, activated partial thromboplastin time （APTY）, fibrino- geM, D-dimer content, hospitalization-related complications and adverse reactions were compared before and after treatment. Results In the control group, venous thrombosis occurred in 1 patient during hospitaliza- tion while no venous thrombosis occurred in the observation group. At 10d after the operation the operation, neither complication nor adverse effect was observed in both groups. In the observation group, the lower limb circumference and lower limb blood flow were significantly better than in the control group. Level of se- rum fibrinogen and D-dimer content was significantly lower in the observation group than in the controlgroup. The activity of anti-FXa, PT and APTY was significantly higher in the observation group than in the control group （all P 〈 O. 01 ）. Conclusion The combination of small molecule heparin and urokinase shows high efficacy in the prevention and treatment of postoperative lower extremities venous thrombosis in patients with gynecological tumors.