低分子肝素对食管癌术后患者深静脉血栓形成的预防效果

Preventive effect of low molecular weight heparin on deep venous thrombosis in patients after esophageal cancer surgery

目的探讨低分子肝素对食管癌术后患者深静脉血栓形成的预防效果。方法收集2017年1月至2020年6月在中国人民解放军联勤保障部队第九〇〇医院接受食管癌手术治疗的168例患者临床资料,并根据术后抗凝药物使用情况将其分为对照组(n=76,术后采取常规抗凝干预)和观察组(n=92,术后采取常规抗凝干预+低分子肝素)。比较两组患者治疗前后的凝血功能指标[血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)]、血液流变学指标(全血高切黏度、全血中切黏度、全血低切黏度)、术后胸腔积液引流量、术后并发症发生情况。结果治疗后,观察组患者的PLT少于对照组患者,Fib、D-D水平均低于对照组患者,PT、APTT均长于对照组患者,差异有统计学意义(P<0.05)。治疗后,观察组患者的全血高切黏度、全血中切黏度、全血低切黏度均低于对照组患者,差异均有统计学意义(P<0.05)。术后,两组患者的胸腔积液引流量比较,差异无统计学意义(P>0.05)。术后,两组患者的血栓性并发症发生率比较,差异有统计学意义(P=0.020)。两组患者切口感染的发生率比较,差异无统计学意义(P>0.05)。结论对食管癌术后患者适当给予低分子肝素进行抗凝治疗,可以在短期内有效改善凝血功能指标及血液流变学指标,降低术后血栓性并发症的发生风险,用药安全性较高。

Objective To analysis the effect of low molecular weight heparin in preventing deep venous thrombosis in patients after esophageal cancer surgery.Method Clinical data of 168 patients undergoing surgery for esophageal cancer at the 900th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2017 to June 2020 was collected and the patients were divided into the control group(n=76,treated with conventional anticoagulation)and the observation group(n=92,treated with conventional anticoagulation+low molecular weight heparin)according to the use of anticoagulant drugs.The changes of coagulation function index[platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)and D-dimer(D-D)],hemorheological indexes(high-shear viscosity of whole blood,mid-shear viscosity of whole blood,low-shear viscosity of whole blood)before and after surgery,the pleural effusion drainage volume and postoperative complications were compared between the two groups.Result After treatment,the PLT of the observation group were shorter,the level of Fib and D-D of the observation group were lower,the PT and APTT longer than those of the control group(P<0.05).After treatment,the high-shear viscosity of whole blood,mid-shear viscosity of whole blood,low-shear viscosity of whole blood were lower than those in the control group(P<0.05).There was no significant difference for the postoperative pleural effusion drainage volume between the two groups(P>0.05).After surgery,the incidence rate of thrombotic diseases between the two groups was compared,and the difference was statistically significant(P=0.020).There was no significant difference for the incidence rate of incision infection between the two groups(P>0.05).Conclusion Appropriate administration of low molecular weight heparin for anticoagulation therapy in patients with esophageal cancer after surgery can effectively improve blood coagulation and hemorheological indicators in a short term,reduce the risk of thrombotic diseases after surgery,and the medication is safe.