胸部肿瘤手术应用不同剂量低分子肝素对凝血机制的影响

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery

目的探讨胸部肿瘤手术后应用不同剂量低分子肝素对凝血机制的影响。方法采用前瞻性随机对照研究,选取2015年2月至2018年10月于本院行胸部肿瘤手术(肺癌、食管癌、贲门癌)的患者,根据Caprini风险评估模型,选取发生深静脉血栓(DVT)风险水平为高危的患者101例,按随机数字表法分配成A、B、C组。对照组A组(34例)术后不予使用低分子肝素;B组(34例)术后使用预防剂量低分子肝素钙,C组(33例)术后使用治疗剂量低分子肝素钙。观测患者术前术后血小板计数(PLT)、纤维蛋白原(FIB)、凝血酶原时间(PT)、D-二聚体(D-D)、术后胸腔引流量,采用下肢深静脉超声检测下肢深静脉血栓(LDVT)发生情况。结果A、B、C三组术后LDVT发生率分别为11.76%(4/34)、2.94%(1/34)、3.03%(1/33),A组高于B、C组,差异有统计学意义(P<0.05),B组与C组之间比较,差异无统计学意义(P>0.05)。各组内术后FIB和D-D水平均明显高于术前,差异有统计学意义(P<0.05),但B、C组术后的FIB和D-D水平明显低于A组,差异有统计学意义(P<0.05);而B组与C组比较,差异无统计学意义(P>0.05)。结论胸部肿瘤患者术后易出现静脉血栓,术后使用低分子肝素钙不会增加出血风险及胸腔引流量,利于改善患者高凝状态,具有良好安全性,但使用不同剂量(预防量、治疗量)低分子肝素钙对减少下肢深静脉血栓的发生以及凝血指标无明显影响。

Objective To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery.Methods A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery(lung cancer,esophageal cancer,cardiac cancer)from February 2015 to October 2018.According to the Caprini risk assessment model,101 patients with high risk of deep venous thrombosis were randomly assigned to groups A,B and C.Control group A(34 cases)did not use low molecular weight heparin;group B(34 cases)used prophylactic low molecular weight heparin calcium after operation;group C(33 cases)used therapeutic low molecular weight heparin calcium after operation.The platelet count(PLT),fibrinogen(FIB),prothrombin time(PT),D-dimer(D-D),postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation.Results The incidence of deep venous thrombosis(DVT)was 11.76%in group A,2.94%in group B and 3.03%in group C,with significant difference between group B and C and group A(P<0.05),but there was no significant difference between group B and C(P>0.05).The levels of FIB and D-D after operation were significantly higher than those before operation(P<0.05),but the levels of indexes in group B and C were significantly lower than those in group A(P<0.05).Conclusions Low molecular weight heparin calcium does not increase bleeding and thoracic drainage,which is beneficial to improve the hypercoagulable state of patients and has good safety.However,the use of low molecular weight heparin calcium in different doses(prevention amount and treatment amount)has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index.