低分子肝素钙在妇科肿瘤腹腔镜术后深静脉血栓预防中的效果观察

Efficacy of low molecular weight heparin calcium in prevention of deep venous thrombosis after laparoscopic surgery for gynecological tumors

目的探讨低分子肝素钙在妇科肿瘤腹腔镜术后深静脉血栓(DVT)预防中的应用效果。方法选取2017年1月至2018年9月间上海市长征医院收治的138例行腹腔镜手术治疗的妇科肿瘤患者,采用随机数字表法分为A组和B组,每组69例。A组患者术前0. 5h单次皮下注射低分子肝素钙5000U,B组患者术后12h皮下注射低分子肝素钙5000U,连用5d。比较两组患者术前和术后5d血小板(PLT)、血红蛋白(Hb)、纤维蛋白原(FIB)和D-二聚体(D-D)水平,统计两组患者手术指标、术后DVT发生率和出血性事件发生情况。结果 A组患者围手术期DVT发生率为2. 9%(2例),B组患者为4. 3%(3例),两组比较,差异无统计学意义(P> 0. 05)。两组患者气腹压力、术中出血量、麻醉时间和手术时间比较,差异均无统计学意义(均P> 0. 05)。术前和术后5d,两组患者FIB、D-D、PLT和Hb水平比较,差异均无统计学意义(均P> 0. 05)。治疗过程中,两组患者均未出现皮下出血和过敏等并发症。结论术前单次低分子肝素钙预防妇科肿瘤腹腔镜手术患者术后DVT发生的效果和安全性与术后应用低分子肝素钙类似,但单次应用减轻了患者的经济负担和注射痛苦,值得临床推广应用。

Objective To investigate the efficacy of low molecular weight heparin calcium in prevention of deep venous thrombosis(DVT)after laparoscopic surgery for gynecological tumors.Methods From January 2017 to September 2018,138 patients with gynecological tumors who underwent laparoscopic surgery at Shanghai Changzheng Hospital were selected as the subjects,and the patients were divided into group A and group B with 69 patients in each group by random number table.Group A received a single subcutaneous injection of low molecular weight heparin calcium 5000 U at 0.5 h before operation,and group B received 5000 U of low molecular weight heparin calcium subcutaneously at 12 h after operation for 5 d.The levels of platelet(PLT),hemoglobin(Hb),fibrinogen(FIB)and D-dimer(D-D)were compared between the two groups before the operation and 5 d after the operation,and the operative indexes,incidence of DVT and the occurrence of hemorrhagic events were analyzed.Results The perioperative incidence of DVT was 2.9%(2 patients)for group A and 4.3%for group B(3 patients)(P>0.05).There was no significant difference in pneumoperitoneal pressure,intraoperative bleeding volume,anesthesia time and operation time between the two groups(all P>0.05).There was no significant difference in FIB,D-D,PLT and Hb levels between the two groups before the operation and at 5 d after the operation(all P>0.05).No complications such as subcutaneous hemorrhage and allergy occurred in both groups.Conclusion The efficacy and safety of single dose of low molecular weight heparin calcium in preventing DVT after gynecological laparoscopic surgery are similar to that of low molecular weight heparin calcium used after surgery,but single dose of low molecular weight heparin calcium reduces the economic burden and injection pain of patients,which is worthy of clinical application.