骨科罹患下肢肌间静脉血栓术前不行规范抗凝直接手术的临床研究

Clinical Study on Patients with Undergo Standard Anticoagulation Before Lower Limb Intermuscular Vein Thrombosis Operation in Orthopedics Department

目的探讨骨科下肢肌间静脉血栓患者术前不行特定周期的规范抗凝治疗,而是预防血栓的同时直接手术是否可行。方法回顾分析2016年1月-2019年12月包头医学院第一附属医院术前经彩超检查确诊下肢肌间静脉血栓141例,根据术前抗凝治疗时间及计量不同分为A组(70例)和B组(71例)。A组抗凝2周,低分子量肝素钙(LMHC)5000IU,2次/d,B组抗凝时间不限,同剂量低分子量肝素钙,1次/d。比较两组住院时间、各不良事件发生率。结果两组住院期间血栓向近端扩展、肺栓塞、出血发生率无较大差异(P>0.05)。住院时间A组明显长于B组,差异显著(P<0.05)。结论手术时机应根据疾病本身及患者自身情况而定,术前无需特定时期的抗凝治疗。下肢肌间静脉血栓危险性并不等同急性近端下肢深静脉血栓,术前无需预防性下腔静脉滤网置入。根据患者自身情况个性化预防性抗凝治疗。

Objective To investigate whether it is feasible for patients with lower limb intermuscular vein thrombosis(IMVT)in orthopedics department to operate directly while preventing thrombosis without specific cycle of standard anticoagulant therapy before operation.Methods The paper reviewed and analyzed 141 cases lower limb intermuscular vein thrombosis diagnosed by color ultrasound in Baotou Medical College The First Affiliated Hospital from January 2016 to December 2019,and divided them into group A(70 cases)and group B(71 cases)according to time and measurement of preoperative anticoagulant treatment.In group A,anticoagulation lasted for 2 weeks,with low molecular weight heparin calcium(LMHC)5000IU,twice a day.In group B,anticoagulation time was unlimited,with same dose of LMHC,once a day.Length of stay and incidence of adverse events was compared between two groups.Results There was no significant difference between two groups in incidence of proximal extension of thrombus,pulmonary embolism and hemorrhage(P>0.05).Length of stay of group A was significantly longer than group B(P<0.05).Conclusion Timing of operation should be determined according to disease itself and conditions of patients,there is no need for anticoagulant treatment at specific period before operation.Risk of lower extremity intermuscular vein thrombosis is not the same as acute proximal lower extremity deep vein thrombosis,there is no need to place preventive inferior vena cava filter screen before surgery.It is necessary to carry on preventive anticoagulation according to individualized conditions of patients.