不同给药频次低分子肝素钙联合气压疗法预防高龄孕产妇产后DVT形成的疗效与安全性研究

Effects and Safety of Different Administration Frequencies of Low Molecular Weight Heparin Calcium Combined with Barometric Therapy in Preventing Postpartum DVT Formation in Elderly Pregnant Women

目的:观察不同给药频次低分子肝素钙联合气压疗法对预防高龄孕产妇(Advanced maternal age,AMA)产后深静脉血栓形成(Deep Vein Thrombosis,DVT)形成的影响。方法:选取2023年1月至2023年12月本院分娩的AMA90名,以随机数字表法分为对照组、观察1组和观察2组,每组30例。对照组给予气压疗法;观察1组和2组分别在对照组基础上皮下注射低分子肝素钙5000 IU 1次•d^(-1)或1次•12 h^(-1),所有产妇均连续5 d。产后1、3、5 d采用全自动凝血分析仪测AMA患者纤维蛋白原(Fibrinogen,Fbg)、活化部分凝血活酶时间(Activated Partial Thromboplastin Time,aPTT)、凝血酶原时间(Prothrombin Time,PT)、凝血酶时间(Thrombin Time,TT)、D2聚体、血红蛋白(Hemoglobin,Hb)水平评价凝血功能;产后1、3、5 d采用动血液流变检测仪测AMA患者全血高切黏度、全血中切黏度等血液流变学指标;产后用药5 d后记录高龄产妇DVT发生率及不良反应发生率。结果:用药第5 d时,观察2组凝血功能相关指标均显著低于观察1组和对照组(P<0.05);观察2组血液流变学指标均显著高于观察1组和对照组(P<0.05);用药5 d后,观察2组DVT发生率显著低于对照组(P<0.05),三组不良反应发生率差异不显著(P>0.05)。结论:低分子肝素钙1次•12 h^(-1)联合气压疗法可改善AMA凝血功能、血液流变学指标,降低DVT发生率,较安全。

Objective:To observe the effects of different administration frequencies of low molecular weight heparin calcium combined with barometric therapy in preventing postpartum deep vein thrombosis(DVT)formation in women of advanced maternal age(AMA).Methods:A total of 90 AMA patients who gave birth in our hospital from January 2023 to December 2023 were selected and randomly divided into a control group,an observation group 1,and an observation group 2 using a random number table method,with 30 cases in each group.The control group received pneumatic therapy;the observation group 1 and observation group 2 received subcutaneous injections of low molecular weight heparin calcium 5000 IU once a day or once every 12 hours on top of the control group,with all mothers receiving treatment for 5 consecutive days.On the 1st,3rd,and 5th days after delivery,the levels of fibrinogen(Fbg),activated partial thromboplastin time(aPTT),prothrombin time(PT),thrombin time(TT),D2-dimer,and hemoglobin(Hb)were measured using a fully automated coagulation analyzer.Also,the levels of whole blood high shear viscosity and whole blood medium shear viscosity were measured using a hemorheology detector to evaluate hemorheology.The incidence of DVT and adverse reactions in the elderly patients were recorded after 5 days of medication.Results:On the 5th day of medication,the coagulation function-related indicators in the observation group 2 were significantly lower than those in the observation group 1 and the control group(P<0.05).The hemorheology indicators in the observation group 2 were significantly higher than those in the observation group 1 and the control group(P<0.05).On the 5th day of medication,the incidence of DVT in the observation group 2 was significantly lower than that in the control group(P<0.05),and there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion:Low molecular weight heparin calcium once every 12 hours combined with pneumatic therapy can improve coagulation function and hemorheology indicators in AMA patients,reduce the incidence of DVT,and is safe.