应用低分子肝素钙预防高血压性脑出血术后深静脉血栓形成的疗效和安全性

Efficacy and safety of low molecular weight heparin calcium in prevention of deep vein thrombosis after hypertensive intracerebral hemorrhage operation

目的探究低分子肝素钙预防高血压性脑出血(HICH)术后深静脉血栓形成(DVT)的疗效和安全性。方法选取2014年1月至2016年6月山东省滕州市中心人民医院收治的98例确诊HICH患者为研究对象,按照随机数字表法分为对照组和观察组,各49例。对照组术后常规治疗,同时每日结合间歇性充气加压装置预防DVT。观察组患者在对照组基础上于手术后第3天开始预防性连续每日腹部皮下注射低分子肝素钙注射液,连用14 d。观察2组患者下肢DVT、肺栓塞和颅内再出血发生情况,手术前和术后规律监测血小板计数、凝血功能指标和D-二聚体水平变化。结果观察组下肢DVT发生率明显低于对照组[2.0%(1/49)比22.4%(11/49)],差异有统计学意义(X^2=3.209,P=0.002),肺栓塞和颅内再出血发生率差异均无统计学意义(均P>0.05)。术前2组血小板计数、凝血功能指标和D-二聚体水平差异均无统计学意义(均P>0.05)。术后14 d观察组血小板计数明显低于,凝血酶原时间、活化部分凝血活酶时间、凝血酶时间明显长于,纤维蛋白原、D-二聚体水平明显低于对照组[(251±20)×10~9/L比(261±24)×109/L、(12.8±0.5)s比(12.2±0.8)s、(33.7±2.4)s比(31.9±2.9)s、(14.2±1.0)s比(13.2±0.9)s、(3.0±0.3)g/L比(3.3±0.3)g/L、(0.99±0.24)mg/L比(1.26±0.28)mg/L],差异均有统计学意义(均P<0.05)。结论 HICH术后患者为DVT高发人群。应用低分子肝素可降低HICH术后DVT发生率,而不增加再出血发生率,安全有效。

Objective To observe the efficacy and safety of low molecular weight heparin （LMWH） calcium in prevention of deep vein thrombosis （DVT） after hypertensive intracerebral hemorrhage （HICH） operation. Methods A total of 98 patients with HICH were enrolled from January 2014 to June 2016 in Tengzhou Central People＇s Hospital of Shandong Province and they were randomly divided into control group and observation group, with 49 cases in each group. Both groups had routine postoperative treatments combined with intermittent pneumatic compression. Patients in observation group had abdominal subcutaneous injection of LMWH calcium for 14 days since the 3rd day after operation. Occurrences of DVT and pulmonary embolism and recurrence of intracerebral hemorrhage were recorded. Changes of platelet count, coagulation function indexes and D-dimer level were analyzed. Results Incidence of lower limb DVT in observation group was significantly lower than that in control group [ 2. 0% （1/49） vs 22. 4% （ 11/49 ） ] （χ2= 3. 209, P = 0. 002 ）. Incidences of pulmonary embolism and cerebral hemorrhage showed no significant differences between groups（P 〉0. 05 ）. Platelet count, coagulation function indexes and D-dimer level showed no significant differences between groups before treatment（ P 〉 0. 05 ）. Fourteen days after operation, piatelet count in observation group was significantly lower, prothrombin time, activated partial thromboplastin time and thrombin time were significantly longer, levels of fibrinogen and D-dimer were significantly lower than those in control group [ （251 ± 20） x 109/L vs （261 ± 24 ） x 109/L, （ 12. 8 ± 0. 5 ） s vs （12.2±0.8）s, （33.7±2.4）s vs （31.9±2.9）s, （14.2±1.0）s vs （13.2 ±0.9）s, （3.0±0.3）g/L vs （3.3 ±0. 3） g/L, （0. 99 ± 0. 24） mg/L vs （ 1.26 ± 0. 28 ） mg/L ] （ P 〈 0. 05 ）. Conclusion Post-HICH patients have a high risk of DVT; LMWH can reduce the incidence rate of DVT without increasing bleeding risk.