低分子肝素对大隐静脉曲张手术患者术后凝血功能的影响

Effect of LMWH on Postoperative Coagulation Function in Patients with Varicosis of Great Saphenous Vein

目的对比不同剂量低分子肝素对大隐静脉曲张手术患者术后凝血功能的影响。方法选取行大隐静脉高位结扎术+导管介入硬化剂注射手术的患者128例,随机分为3组:Ⅰ组(对照组)42例,其中C3型24例,C4型18例;Ⅱ组(低分子肝素5000U每日1次组)45例,其中C3型20例,C4型25例;Ⅲ组(低分子肝素5000U每日2次组)41例,其中C3型22例,C4型19例。观察3组患者术前和术后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)以及抗-Xa因子活性等凝血功能变化。结果术前3组PT、APTT、Fib、D-D值均在正常范围内,3组间比较差异无统计学意义(P>0.05)。术后3组PT延长,APTT逐渐减少,Fib、DD升高,抗-Xa因子活性术后逐渐升高,与术前比较差异均有统计学意义(P<0.05)。术后Ⅲ组Fib明显低于Ⅱ组(P<0.05)。术后Ⅲ组D-D低于Ⅱ组(P<0.05);术后Ⅲ组D-D明显低于Ⅰ组(P<0.05)。术后Ⅲ组抗-X a因子活性高于Ⅱ组(P<0.05)。结论在一定的体重范围内,对大隐静脉曲张手术患者标准化使用低分子肝素针,可预防深静脉血栓发生,防止术后出血并发症。

Objective To compare the effects of low molecular weight heparin （LMWH） of difference doses on postoperative coagulation function in patients with varicosis of great saphenous vein. Methods 128 patients after high ligation of greatsaphenous vein plus catheter invention with sclerosant injection were selected and randomly divided into 3groups： group I （control group, n = 42, including 24 cases of type C3and 18 cases of type C4）, group II （5000U LM- WH, once a day,n =45, including 20 cases of type C3and 25 cases of type C4） and group III （5000U LMWH, twice a day, n =41, including 22 cases of type C3 and 19 cases of type C4） ; observation was made to the changes of coagu- lation function of all the cases in the 3 groups, including the changes of prothrombin time （PT）, activated partial thromboplastin time （APIT）, fibrinogen （Fib） levels, D-Dimer （D-D） and anti-factor Xa activity before and after operation. Results The pre-operative values of FF, APTT, Fib and D-D of the cases in the 3 groups were normal, the comparison among the 3 was of no statistical significance （ P 〉 0. 05 ） ; the post-operative PT prolonged while APTY de- creased, Fib and D-D increased and anti-factor Xa activity kept raising, compared with those before operation, the difference was of statistical significance （ P 〈 0. 05 ） ; after operation , the level of Fib and D-D in group III were lower than those in group II while anti-factor Xa activity in group III was higher than that in group II （ P 〈 0. 05 ）. Conclu- sions The standarized application of LMWH in patients of certain weight after great saphenous varicose veins surgery can prevent the occurrence of deep venous thrombosis and host-operative bleeding,