低分子肝素钠预防妇科肿瘤围手术期下肢深静脉血栓的疗效与安全性

Efficacy and safety of low molecular weight heparin in prevention of deep vein thrombosis in gynecologic tumors during perioperative period

目的探讨低分子肝素钠预防妇科肿瘤围手术期下肢深静脉血栓(lower extremity deep venous thrombosis of lower extremity,LEDVT)的临床效果和用药安全性。方法选择2015年1月至2017年4月如皋市人民医院和南通市第一人民医院行手术治疗的84例妇科肿瘤患者,根据入院日期单双数分成两组,各42例,对照组围手术期给予常规治疗处理,观察组在此基础上预防性使用低分子肝素钠。观察两组患者手术前后凝血功能和纤溶系统指标的变化,术后LEDVT的发生率以及药物不良反应。结果用药1周后两组的凝血酶原时间、活化部分凝血活酶时间和纤维蛋白原等凝血指标,以及D-二聚体、抗凝血酶Ⅲ和组织型纤溶酶原激活物等纤溶系统指标比较,差异有统计学意义(P <0. 05);术后1周内观察组的LEDVT发生率(4. 76%)明显低于对照组(14. 3%),差异有统计学意义(P <0. 05);两组不良反应发生率比较,差异无统计学意义(P>0. 05)。结论妇科肿瘤患者在围手术期预防性使用低分子肝素钠,能改善患者的凝血和纤溶系统指标,降低术后LEDVT发生率,促进疾病恢复,用药安全性较高,可作为妇科肿瘤围手术期防治LEDVT的预防性用药。

Objective To explore the clinical efficacy and safety of low molecular weight heparin in preventing deep vein thrombosis（ LEDVT） of gynecological tumors during perioperative period. Methods 84 cases of gynecologic tumor patients in Rugao People＇s Hospital and Nantong First People＇s Hospital from January 2015 to April 2017 were divided into two groups according to the single and even number of admission dates,with 42 cases in each group. The control group was treated with routine treatment during the perioperative period. The observation group used prophylactic use of low molecular weight heparin sodium on this basis. The changes of coagulation function and fibrinolytic system index before and after operation,the incidence of postoperative LEDVT and adverse drug reactions were observed. Results 1 weeks after medication, the prothrombin time, activated partial thromboplastin timeand fibrinogen,as well as D-two polymer,The indexes of fibrinolytic system,such as total name of antithrombin III,and tissue type plasminogen activator were compared,and the differences were statistically significant（ P〈0. 05）,and the incidence of LEDVT in the observation group was significantly lower within 1 weeks after the operation. In the control group,the difference was statistically significant（ P〈0. 05）; there was no significant difference in the adverse reaction rate between the two groups（ P〈0. 05）. Conclusion The preventive use of low molecular weight heparin sodium in the perioperative period of gynecologic tumor can improve the index of coagulation and fibrinolysis,reduce the incidence of DVT in the lower extremities,promote the recovery of the disease,and have high safety. It can be used as a precontrol drug for the prevention and treatment of lower extremity DVT in the perioperative period of gynecologic tumor.