低分子肝素预防妇科手术后静脉血栓形成的临床观察

Clinical Observation on Prevention of Venous Thrombosis after Gynecologic Operation with Low Molecular Weight Heparin

目的评价低分子肝素在妇科手术后预防静脉血栓形成的疗效及安全性.方法将245例行妇科手术治疗的Caprini评分极高危的患者分为预防抗凝组112例,术后第1~7天每天皮下注射低分子肝素4100U;非预防抗凝组133例,术后未行抗凝治疗.统计两组术后静脉血栓(VTE)发生率、观察抗凝治疗的不良反应,监测凝血功能,行统计学分析.结果预防抗凝组术后发生3例VTE,发生率1.79%(3/112);非预防抗凝组术后发生16例VTE,发生率9.02%(16/133);预防抗凝组VTE术后发生率较非抗凝组显著降低(P<0.05).预防性抗凝治疗后患者的PT、TT、APTT延长(P<0.05);而FIB、D2、PLT减少(P<0.05).预防抗凝组应用LMWH的不良反应轻微.结论妇科手术后易伴发VTE,低分子肝素预防妇科手术后VTE疗效确切且安全.

Objective To evaluate the efficacy and safety of low molecule weight heparin in preventing venous thrombosis after gynecologic surgery. Methods The patients with extremely high risk of Caprini score treated with 245 gynecologic operations were divided into 112 preventive anticoagulant groups. Low molecule weight heparin 4100U injected subcutaneous daily for the first to seventh day of operation. Non-preventive anticoagulant group was 133 cases without the treatment of low molecular weight Heparin after operation. Then the differences in the incidence of venous thrombosis(VTE) after operation were compared between both groups. The coagulation function and the adverse effects of anticoagulant therapy were analyzed. Results The resulis showed that there were 3 cases of VTE occurred In the prevention anticoagulant group (3/112) and 16 Cases of VTE in the non-preventive anticoagulant group(16/133), the incidence of thrombosis decreased significantly In the prevention anticoagulant group(1.79% vs 9.02 %,P<0.05). PT, TT, APTT in the patients after preventive anticoagulant treatment increased significantly (P<0.05);and FIB, D2, PLT decreased significantly (P<0.05). The adverse effects of LMWH on anticoagulant group were mild. Conclusion VTE is easy to accompany after gynecological surgery. Low molecular weight Heparin is effective and safe after gynecological surgery.