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
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摘要
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.
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.
引文
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[13]李战辉,何志聪,陈赟,等.小剂量尿激酶、低分子肝素钙和奥扎格雷钠联合抗栓治疗急性脑梗死的临床研究[J].中华神经医学杂志,2012,11:713-716.
[14]谭丽梅.低分子肝素钙预防妇科肿瘤腹腔镜术后深静脉血栓的临床效果观察[J].深圳中西医结合杂志,2018,28:172-173.
[15]申沛,林耀蕙,郭伟平,等.低分子肝素联合香丹注射液预防妇科恶性肿瘤腹腔镜手术后静脉血栓性疾病[J].实用医药杂志,2015,32:607-609.
[16]黄润强,郭振鹏,袁修琼,等.低分子肝素钙在妇科肿瘤腹腔镜术后预防深静脉血栓中的临床效果[J].现代肿瘤医学,2017,25:444-447.
[17]郭海雁,王庆一,黄春建.开腹及腹腔镜下全子宫切除术后并发下肢深静脉血栓形成的临床分析[J].中国妇幼保健,2008,23:1736-1737.
[18]劳建新,张永福,王琼,等.硬膜外阻滞对妇科腹腔镜手术患者血液流变学的影响[J].南方医科大学学报,2010,30:338-340.
[19]邢雪君,任蕾,杜桂琴,等.妇科肿瘤患者凝血功能的相关分析[J].血栓与止血学,2014,20:71-73.
[20]何小科,邱振雄,刘维藩.低分子肝素钙预防腹腔镜术后下肢深静脉血栓形成的作用[J].中国现代普通外科进展,2012,15:583-585.
[21]邱振雄,刘维藩.经T管窦道胆道镜探查在多发胆管结石术后应用体会[J].吉林医学,2010,31:3537-3538.
[2]韩娜娜,薛峰,王娟,等.传统手术与腹腔镜手术治疗早期老年子宫内膜癌患者的临床疗效[J].中国老年学杂志,2014,34:4862-4863.
[3]王霞,杨梅,盛楠,等.宫颈癌腹腔镜与开腹手术术后静脉血栓栓塞症发生率的Meta分析[J].中国实用妇科与产科杂志,2018,34:772-777.
[4]张海燕.妇科腹腔镜手术后下肢深静脉血栓形成的临床分析[J].腹腔镜外科杂志,2014,19:433-436.
[5]何小科,邱振雄,刘维藩.低分子肝素钙预防腹腔镜术后下肢深静脉血栓形成的作用[J].河南外科学杂志,2012,18:6-8.
[6]张颖佳,刘思华,张军.低分子肝素钙注射液联合逐级加压弹力袜预防妇科腹腔镜手术后下肢深静脉血栓[J].中国微创外科杂志,2018,18:581-584.
[7]Linda H,Shahidul I,Alexander H.Utilization rates of enoxaparin and heparin in deep venous thrombosis prophylaxis after education and electronic order change at a single institution:a quality improvement study[J].J Thromb Thrombolysis,2018,46:502-506.
[8]王胜花.妇科腹腔镜手术下肢静脉血栓的研究进展[J].中国误诊学杂志,2012,12:769-770.
[9]Sakon M,Maehara Y,Yoshikawa H,et al.The incidence of venous thrombus embolism following major abdominal surgery:a multi-center prospective epidemiological study in Japan[J].JThromb Haemost,2006,4:581-588.
[10]黄红莲,莫爱旭.妇科腹腔镜手术后患者下肢深静脉血栓形成的相关因素分析[J].医学临床研究,2015,32:146-148.
[11]Robinson R,Wirt TC,Barbosa C,et al.Routine use of low-molecular-weight heparin for deep venous thrombosis prophylaxis after foot and ankle surgery:a cost-effectiveness analysis[J].JFoot Ankle Surg,2018,57:543-551.
[12]闫绍辉,王栋,李湘红,等.恶性肿瘤患者高凝状态与血栓形成的临床研究[J].中国肿瘤临床与康复,2014,21:542-544.
[13]李战辉,何志聪,陈赟,等.小剂量尿激酶、低分子肝素钙和奥扎格雷钠联合抗栓治疗急性脑梗死的临床研究[J].中华神经医学杂志,2012,11:713-716.
[14]谭丽梅.低分子肝素钙预防妇科肿瘤腹腔镜术后深静脉血栓的临床效果观察[J].深圳中西医结合杂志,2018,28:172-173.
[15]申沛,林耀蕙,郭伟平,等.低分子肝素联合香丹注射液预防妇科恶性肿瘤腹腔镜手术后静脉血栓性疾病[J].实用医药杂志,2015,32:607-609.
[16]黄润强,郭振鹏,袁修琼,等.低分子肝素钙在妇科肿瘤腹腔镜术后预防深静脉血栓中的临床效果[J].现代肿瘤医学,2017,25:444-447.
[17]郭海雁,王庆一,黄春建.开腹及腹腔镜下全子宫切除术后并发下肢深静脉血栓形成的临床分析[J].中国妇幼保健,2008,23:1736-1737.
[18]劳建新,张永福,王琼,等.硬膜外阻滞对妇科腹腔镜手术患者血液流变学的影响[J].南方医科大学学报,2010,30:338-340.
[19]邢雪君,任蕾,杜桂琴,等.妇科肿瘤患者凝血功能的相关分析[J].血栓与止血学,2014,20:71-73.
[20]何小科,邱振雄,刘维藩.低分子肝素钙预防腹腔镜术后下肢深静脉血栓形成的作用[J].中国现代普通外科进展,2012,15:583-585.
[21]邱振雄,刘维藩.经T管窦道胆道镜探查在多发胆管结石术后应用体会[J].吉林医学,2010,31:3537-3538.