不同剂量低分子肝素预防腰椎内固定术后静脉血栓栓塞症的安全性分析

Safety Analysis of Different Doses of Low Molecular Weight Heparin in Preventing Venous Thromboembolism after Lumbar Internal Fixation

目的比较不同剂量低分子肝素预防腰椎内固定术后静脉血栓栓塞症(venous thromboembolism,VTE)的安全性。方法选取我院2020年7月1日至2020年12月31日行腰椎后路内固定手术的206例病人,随机分为A组和B组。其中A组103例,男56例,女47例,年龄为(45±15)岁,术后每天应用5000 IU低分子肝素附加物理方法预防VTE;B组103例,男50例,女53例,年龄为(46±16)岁,术后每天应用2500 IU低分子肝素附加物理方法预防VTE。均抗凝治疗10 d,其他治疗相同。分别记录并分析两组术后第3、5、10天的D-二聚体值、凝血功能、血小板(PLT)值、肝功能,以及引流管拔除时间、伤口出血或血肿发生例数、血栓发生例数、住院天数。结果A组术后2例(1.94%)发生下肢DVT,28例(27.18%)伤口渗血;B组术后1例(0.97%)发生下肢DVT,3例(2.91%)伤口渗血。两组的DVT发生率、引流管拔除时间比较,差异无统计学意义(P>0.05)。两组的术后出血发生率、住院天数比较,差异有统计学意义(P<0.05)。两组均未出现术后血肿压迫引起神经症状病例。A组术后3、5、10 d的各项肝功能指标和凝血指标的数值均较B组显著升高,差异有统计学意义(P<0.05)。两组的PLT数值基本维持正常状态,组间比较,差异无统计学意义(P>0.05)。结论低分子肝素预防腰椎内固定术后VTE的疗效确切,但每日5000 IU的用量会增加术后伤口出血风险,影响病人肝功能、凝血功能,延长住院时间,建议采取每日2500 IU剂量的低分子肝素预防腰椎内固定术后VTE。

Objective To compare the safety of different doses of low molecular weight heparin in preventing venous thromboembolism(VTE)after lumbar internal fixation.Methods A total of 206 cases of posterior lumbar internal fixation in our hospital from July 1,2020 to December 31,2020 were randomly divided into group A and group B.Among them,103 patients in group A,including 56 males and 47 females,aged(45±15)years old,were treated with 5000 IU low molecular weight heparin per day plus physical methods to prevent VTE.There were 103 cases in group B,including 50 males and 53 females,aged(46±16)years old.They were treated with 2500 IU low molecular weight heparin daily after surgery plus physical methods to prevent VTE.All were treated with anticoagulation for 10 days,and the rest treatments were the same.The D⁃dimer value,coagulation function,platelet(PLT)value,liver function,drainage tube removal time,wound bleeding or hematoma cases,thrombosis cases on the 3rd,5th,and 10th day after operation and length of hospital stay were recorded and analyzed.Results In group A,2 cases(1.94%)had lower limb DVT after operation,and 28 cases(27.18%)had wound bleeding.In group B,1 case(0.97%)had lower limb DVT after operation,and 3 cases(2.91%)had wound bleeding.There was no statistically significant difference in the incidence of DVT and drainage tube removal time between the two groups(P>0.05).There was a statistically significant difference in the incidence of postoperative bleeding and the length of hospital stay between the two groups(P<0.05).The values of liver function indexes and blood coagulation indexes at 3,5,and 10 days after operation in group A were significantly higher than those in group B,and the difference was statistically significant(P<0.05).The platelet values in the two groups basically maintained a normal state,and the difference between the groups was not statistically significant(P>0.05).There were no cases of neurological symptoms caused by postoperative hematoma compression in both groups.Conclusion Low⁃molecular⁃weight heparin is effective in preventing VTE after lumbar internal fixation,but the daily dosage of 5000 IU will increase the risk of postoperative wound bleeding,affect the patient’s liver function,coagulation function,and prolong the hospital stay.It is recommended to take a low dose of 2500 IU low⁃molecular⁃weight heparin to prevent VTE after lumbar internal fixation.