低分子肝素联合气压治疗预防剖宫产术后下肢深静脉血栓的临床效果

Clinical Effect of Low Molecular Weight Heparin Combined with Pneumatic Compression in the Prevention of Deep Venous Thrombosis After Cesarean Section

目的研究低分子肝素(LMWH)联合气压治疗预防剖宫产术后下肢深静脉血栓(DVT)的临床效果。方法以2020年10月-2021年3月信丰县中医院拟行剖宫产术的60例DVT高风险孕妇为研究对象,经随机数字表法分为对照组(30例)与观察组(30例),对照组于术后当天给予间歇性气囊加压治疗,观察组则在其基础上联合低分子肝素治疗,比较两组凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白原(FIB)、血小板计数(PLT)]、术后出血量、术后不良症状、出血倾向特征(皮肤瘀斑、牙龈出血、阴道流血增多)、下肢静脉血管超声检查结果(左、右股静脉血流速度、DVT发生率)。结果两组治疗后PT、TT高于治疗前,D-D、FIB、PLT低于治疗前,且观察组PT、TT高于对照组,D-D、FIB、PLT低于对照组(P<0.05);两组术后12、24 h出血量比较,差异无统计学意义(P>0.05);两组术后不良症状发生率比较,差异无统计学意义(P>0.05);两组术后出血倾向特征比较,差异无统计学意义(P>0.05);观察组左、右股静脉血流速度大于对照组,且DVT发生率小于对照组(P<0.05)。结论低分子肝素联合气压治疗可改善剖宫产产妇的凝血功能,预防DVT,且不增加产妇术后出血量,出血倾向低,不良症状少,安全性高。

Objective To study the clinical effect of low molecular weight heparin(LMWH)combined with pneumatic compression therapy in the prevention of deep venous thrombosis(DVT)after cesarean section.Methods From October 2020 to March 2021,60 pregnant women with high risk of DVT who planned to undergo cesarean section in Xinfeng County Hospital of Traditional Chinese Medicine were selected as the research objects.They were divided into control group(30 pregnant women)and observation group(30 pregnant women)by random number table method.The control group was treated with intermittent pneumatic compression on the day after operation,while the observation group was treated with low molecular weight heparin on the basis of the control group.The coagulation function indexes[prothrombin time(PT),thrombin time(TT),D-dimer(D-D),fibrinogen(FIB),platelet count(PLT)],postoperative bleeding volume,postoperative adverse symptoms,bleeding tendency characteristics(skin ecchymosis,gingival bleeding,vaginal bleeding),lower extremity venous vascular ultrasound examination results(left and right femoral vein blood flow velocity,DVT incidence)were compared between the two groups.Results After treatment,PT and TT in the two groups were higher than those before treatment,D-D,FIB and PLT were lower than those before treatment,and PT and TT in the observation group were higher than those in the control group,D-D,FIB and PLT were lower than those in the control group(P<0.05).There was no significant difference in the amount of bleeding between the two groups at 12 and 24 h after operation(P>0.05).There was no significant difference in postoperative adverse symptoms between the two groups(P>0.05).There was no significant difference in the characteristics of postoperative bleeding tendency between the two groups(P>0.05).The blood flow velocity of left and right femoral vein in the observation group was higher than that in the control group,and the incidence of DVT was lower than that in the control group(P<0.05).Conclusion Low molecular weight heparin combined with pneumatic compression therapy can improve the coagulation function of cesarean section women,prevent DVT,and do not increase the amount of postoperative bleeding,with lower bleeding tendency,fewer adverse symptoms and higher safety.