血栓弹力图在阿司匹林预防晚期肺癌患者PICC相关性静脉血栓疗效监测中的应用

Application of Thrombocyte Bomb in the Monitoring of PICC Associated Venous Thrombosis in Patients with Advanced Lung Cancer with Aspirin

目的采用血栓弹力图监测阿司匹林抗血栓疗效以预防晚期肺癌患者PICC相关性静脉血栓,为临床治疗提供参考依据。方法对2017年3月-2018年11月某院肿瘤治疗中心住院行PICC置管的晚期肺癌患者247例,随机分为观察组124例和对照组123例,2组患者均于置管当天开始口服阿司匹林,100mg/次,每天一次,并于置管后4周内每周行多普勒超声检测静脉血栓形成情况,同时观察组于置管后2天检测TEG,血小板抑制无效者予加大服药剂量或更换新药抗凝治疗,起效和有效者维持原抗凝治疗。记录观察组血小板抑制率及处理情况、2组PICC相关性静脉血栓发生情况。结果观察组阿司匹林治疗无效11例,起效104例,有效9例,无效者行阿司匹林联合氯吡格雷双抗治疗,起效和有效者维持原阿司匹林治疗;观察组无1例静脉血栓形成,对照组静脉血栓形成8例,2组静脉血栓形成率比较,差异有统计学意义(χ^2=6.391,P<0.05),对照组静脉血栓形成者平均年龄(74.52±6.71)岁,男女比例为1:7。结论使用TEG评估晚期肺癌PICC患者阿司匹林抗血小板的疗效,为患者建立个体化的抗血栓治疗,能有效避免PICC相关性静脉血栓形成,其应用前景好,值得临床推广。

Objectives Using thrombus bullet to monitor the antithrombotic effect of aspirin to prevent PICC associated venous thrombosis in patients with advanced lung cancer provides a reference for clinical treatment.Methods The selected cases were 247 cases of advanced lung cancer patients who were hospitalized with PICC in a hospital oncology center from March 2017 to November 2018.Patients were randomly divided into 124 cases in observation group and 123 cases in control group.Both groups of patients began to take aspirin orally on the same day of implantation,100 mg/times,QD,and Diagnosis of venous thrombosis by Doppler ultrasound every week within 4 weeks after implantation.At the same time,the observation group tested TEG after 2 D.Those who have no platelet inhibition are given increased doses of medication or replacement of new anticoagulant drugs,effective and effective maintenance of original anticoagulant therapy.Record platelet inhibition rate and treatment,PICC associated venous thrombosis.Results Aspirin was invalid in 11 cases,effective in 104 cases and effective in 9 cases,Patients who are ineffective are treated with aspirin combined with clopidogrel,and patients who are effective and effective maintain the original aspirin treatment;There was no venous thrombosis in the observation group and 8 in the control group.There was a statistically significant difference in the rate of venous thrombosis between the two groups(χ^2=6.391,P<0.05).The mean age of patients with venous thrombosis in the control group was(74.52±6.71)years,male to female ratio was 1:7.Conclusions Using TEG to evaluate the antiplatelet efficacy of aspirin in patients with advanced lung cancer and to establish individual antithrombotic therapy for patients could effectively avoid PICC-related venous thrombosis.Its application prospects were good and it is worth clinical promotion.