磺达肝癸钠预防骨肉瘤患者术后深静脉血栓的效果及对凝血功能的影响

The effect of fondaparinux in the prevention of postoperative deep vein thrombosis in patients with osteosarcoma and its effect on coagulation function

目的探讨磺达肝癸钠预防骨肉瘤患者术后深静脉血栓(DVT)的效果及对凝血功能的影响。方法将90例骨肉瘤患者分为试验组与对照组各45例。两组均于术后6~8 h开始接受抗凝治疗,对照组采用低分子肝素钙注射液,试验组采用磺达肝癸钠注射液治疗,均持续用药至术后10~14 d。比较两组DVT发生率,治疗前后凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)、白细胞计数(WBC)、血小板计数(PLT)表达,谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(SCr)的变化,以及两组出血不良反应发生率。结果两组DVT发生率及治疗后APTT、FIB、D-D比较,差异无统计学意义(P>0.05);试验组PLT明显高于对照组,SCr明显低于对照组(P<0.05);两组出血不良反应发生率比较,差异无统计学意义(P>0.05)。结论磺达肝癸钠、低分子肝素均能有效预防骨肉瘤患者术后DVT的发生,改善凝血功能,但磺达肝癸钠对PLT、肾功能的影响更小,有较好的临床应用前景。

Objective To explore the effect of fondaparinux in the prevention of postoperative deep vein thrombosis(DVT)in patients with osteosarcoma and its effect on coagulation function.Methods Ninety patients with osteosarcoma were divided into an experimental group and a control group,45 in each group. Both groups began receiving anticoagulant treatment after 6-8 hours of surgery.The control group was treated with low molecular weight heparin calcium injection while the experimental group was treated with fondaparinux sodium injection. Both groups continued to take the medicines until 10-14 days after surgery.The incidence of DVT was compared between the two groups.The changes of the thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),D-dimer(D-D),white blood cell count(WBC),platelet count(PLT),alanine aminotransferase(ALT),aspartate amin-otransferase(AST)and serum creatinine(SCr)before and after treatment as well as the incidence of adverse bleeding reactions was compared between the two groups.Results There was no statistical difference in the incidence of DVT and APTT,FIB,D-D after treatment between two groups(P>0.05).The PLT in the experimental group was significantly higher than that in the control group,and the SCr in the experimental group was significantly lower than that in the control group(P<0.05).There was no statistical difference in the incidence of adverse bleeding reactions between the two groups(P>0.05).Conclusions Both fondaparinux and low molecular weight heparin can effectively prevent the postoperative DVT in patients with osteosarcoma,and improve the coagulation function. However,fondaparine has less effect on PLT and renal function,and have a good clinical application prospect.