不同剂量磺达肝葵钠联合机械方法在宫颈癌术后VTE预防中的应用价值

Application value of different doses of fondaparinux sodium combined with mechanical method in the prevention of VTE after cervical cancer surgery

目的 分析不同剂量磺达肝葵钠联合机械方法在宫颈癌术后静脉血栓栓塞症(VTE)预防中的应用价值。方法 选取2019年1月至2022年1月达州市中心医院收治的并行根治术治疗的宫颈癌患者165例为研究对象,数字随机法分为低剂量组(n=55)、中剂量组(n=55)和高剂量组(n=55),三组患者均于术前1日给予气压治疗,术后24 h低剂量组给予1.5 mg磺达肝癸钠,中剂量组给予2.5 mg磺达肝癸钠,高剂量组给予3.5 mg磺达肝癸钠,比较三组的凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]、下肢周径差、炎症因子指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)]、深静脉血栓栓塞(DVT)、肺栓塞(PE)及不良反应的发生率。结果 治疗后中、高剂量组APTT、PT均高于低剂量组,FIB、CRP、TNF-α、IL-8水平和大腿周径差、小腿周径差均低于低剂量组(P <0.05);住院期间,中、高剂量组DVT发生率均为1.82%,低于低剂量组的12.73%(P <0.05),三组PE发生率比较差异无统计学意义(P>0.05);低、中剂量组不良反应发生率为5.45%、7.27%,低于高剂量组的23.64%(P <0.05)。结论中剂量磺达肝葵钠联合机械方法和高剂量磺达肝葵钠联合机械方法均可改善宫颈癌术后患者血液高凝和黏滞状态,降低机体炎症反应和DVT发生率,但前者安全性更高。

Objective To analyze the application value of different doses of fondaparinux sodium combined with mechanical method in the prevention of VTE after cervical cancer surgery.Methods A total of 165 cervical cancer patients who underwent radical operation in Dazhou Central Hospital from January 2019 to January 2022 were selected as the research subjects,and divided into low-dose group(n=55),medium-dose group(n=55) and high-dose group(n=55) by random number table method.All patients were given air pressure treatment 1d before operation.At 24h after operation,the low-dose group,the medium-dose group and the high-dose group were treated with 1.5 mg,2.5 mg and 3.5mg of fondaparinux sodium,respectively.Coagulation function indicators [activated partial thromboplastin time(APTT),prothrombin time(PT) and fibrinogen(FIB)],lower limb circumference difference,inflammatory factors [C-reactive protein(CRP),tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8)],the incidence rates of deep venous thrombosis(DVT),pulmonary embolism(PE) and adverse reactions were compared among the 3 groups.Results After treatment,APTT in the medium-dose group and the high-dose group were longer than those in the low-dose group.The levels of FIB,CRP,TNF-α and IL-8,thigh circumference difference and calf circumference difference were significantly lower/smaller than those in the low-dose group(P 0.05).The incidence rates of adverse reactions in the low-dose group and the medium-dose group(5.45% and 7.27%) were significantly lower than that in the high-dose group(23.64%)(P<0.05).Conclusion Both medium-dose and high-dose fondaparinux sodium combined with mechanical method can improve blood hypercoagulabale state and viscous state in patients after cervical cancer surgery,and reduce the incidence rates of inflammatory response and DVT.However,the former is safer.