依诺肝素联合梯度弹力袜预防血栓高风险孕妇剖宫产后VTE的价值

Value of Enoxaparin Combined with Graduated Compression Stockings in Preventing VTE in Gravida with High-risk of Thrombosis after Cesarean Section

目的:探究依诺肝素联合梯度弹力袜预防血栓高风险孕妇剖宫产后静脉血栓栓塞(VTE)的价值。方法:回顾性选取2023年1—7月在鹰潭市人民医院行剖宫产的80例血栓高风险孕妇,根据术后预防VTE的方法不同将其分为对照组(n=38)和观察组(n=42)。对照组术后给予梯度弹力袜,观察组在对照组基础上加用依诺肝素。比较两组手术前后凝血功能指标、下肢静脉血流速度、术后恢复情况、VTE发生率。结果:术后10 d,观察组凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)均长于对照组,D-二聚体(D-D)、血小板计数(PLT)和纤维蛋白原(FIB)均低于对照组,差异均有统计学意义(P<0.05)。观察组术后10 d股静脉血流平均流速和血流峰速均高于对照组,差异均有统计学意义(P<0.05)。两组术后出血倾向发生率比较,差异无统计学意义(P>0.05);观察组住院时间短于对照组,差异有统计学意义(P<0.05)。观察组术后VTE发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:血栓高风险孕妇剖宫产后应用依诺肝素联合梯度弹力袜可改善高凝血状态,促进下肢血液循环,降低VTE发生率。

Objective:To investigate the value of Enoxaparin combined with graduated compression stockings in preventing venous thromboembolism(VTE)in gravida with high-risk of thrombosis after cesarean section.Method:A total of 80 gravidas with high-risk of thrombosis who underwent cesarean section in Yingtan City People's Hospital from January to July 2023 were retrospectively selected and divided into control group(n=38)and observation group(n=42)according to different methods of postoperative VTE prevention.The control group was given graduated compression stockings after surgery,and the observation group was given Enoxaparin on the basis of the control group.The coagulation function indexes,lower limb venous blood flow velocity before and after surgery,postoperative recovery and incidence of VTE were compared between the two groups.Result:10 d after surgery,the prothrombin time(PT)and activated partial thromboplastin time(APTT)in observation group were longer than those in control group,and D-dimer(D-D),platelet count(PLT)and fibrinogen(FIB)in observation group were lower than those in control group,the differences were statistically significant(P<0.05).10 d after surgery,the average flow velocity and peak flow velocity of femoral vein in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative bleeding tendency between the two groups(P>0.05).The hospitalization time of observation group was shorter than that of control group,the difference was statistically significant(P<0.05).The incidence of postoperative VTE in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:The application of Enoxaparin combined with graduated compression stockings after cesarean section can improve the hypercoagulable state,promote lower limb blood circulation and reduce the incidence of VTE.