肺癌患者术后抗凝药物的不同干预时间对凝血功能的影响
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摘要
目的:研究肺癌患者术后应用低分子肝素钙抗凝不同的起始时间对患者凝血功能的影响。方法:分析2017年11月至2018年5月我科收治的肺癌手术患者,按照手术顺序采用SPSS 19.0随机分成A、B、C、D组。其中A、B、C组为抗凝组,分别于术后12 h、24 h、48 h给予低分子肝素钙4 100 IU,bid,皮下注射,连续应用7天;D组为空白对照组。抗凝组和空白对照组术后都给予基础的血栓预防措施。术前及术后连续5天查血常规和血栓弹力图(TEG)并监测术后胸引量及下肢静脉血栓形成情况。结果:4组肺癌术后患者的下肢血栓形成情况:A组0例,B组1例下肢肌间静脉血栓形成,C组2例下肢肌间静脉血栓形成,D组6例肌间静脉血栓形成。A组与D组之间比较有显著差异。所有肺癌患者术后没有出现临床症状的静脉血栓栓塞症。血栓弹力图指标术前均无显著差异,而R值在术后组间比较均有显著差异。4组肺癌患者术后胸引量和出血相关并发症组间比较无显著差异。结论:肺癌术后12 h应用低分子肝素钙预防性抗凝治疗能明显降低静脉血栓形成的风险,优于24 h、48 h开始抗凝治疗。
Objective:To study the effect of different initiation time of anticoagulation with low-molecular-weight heparin calcium on coagulation function in patients with lung cancer.Methods:Patients with lung cancer treated in our department from November 2017 to May 2018 were analyzed and randomly divided into groups A,B,C,and D according to the surgical sequence using SPSS 19.0.Among them,group A,B,and C were anticoagulation groups.They were given low-molecular-weight heparin calcium 4 100 IU at 12 h,24 h,and 48 h after surgery,respectively,bid,and injected subcutaneously for 7 days.D group was a blank control group.Both the anticoagulation group and the blank group were given basic thromboprophylaxis after surgery.Blood routine and thromboelastogram(TEG) were examined preoperatively and postoperatively for 5 consecutive days,and postoperative chest volume and venous thrombosis in the lower extremities were monitored.Results:The thrombosis of lower limbs in 4 groups of patients with lung cancer after surgery:0 in group A,1 intramuscular venous thrombosis in lower extremities in group B,2 intramuscular venous thrombosis in lower extremities in group C,and 6 intramuscular venous thrombosis in group D.There was a significant difference between group A and group D.All patients with lung cancer had no clinical signs of venous thromboembolism.There were no significant differences in preoperative thrombelastographic parameters,and R values were significantly different between the postoperative groups.There was no significant difference in postoperative chest volume and bleeding-related complications between the 4 groups of lung cancer patients.Conclusion:The use of low-molecular-weight heparin calcium prophylactic anticoagulation therapy can significantly reduce the risk of venous thrombosis at 12 h after lung cancer surgery,and it is better than anticoagulation therapy initiated at 24 h and 48 h.
Objective:To study the effect of different initiation time of anticoagulation with low-molecular-weight heparin calcium on coagulation function in patients with lung cancer.Methods:Patients with lung cancer treated in our department from November 2017 to May 2018 were analyzed and randomly divided into groups A,B,C,and D according to the surgical sequence using SPSS 19.0.Among them,group A,B,and C were anticoagulation groups.They were given low-molecular-weight heparin calcium 4 100 IU at 12 h,24 h,and 48 h after surgery,respectively,bid,and injected subcutaneously for 7 days.D group was a blank control group.Both the anticoagulation group and the blank group were given basic thromboprophylaxis after surgery.Blood routine and thromboelastogram(TEG) were examined preoperatively and postoperatively for 5 consecutive days,and postoperative chest volume and venous thrombosis in the lower extremities were monitored.Results:The thrombosis of lower limbs in 4 groups of patients with lung cancer after surgery:0 in group A,1 intramuscular venous thrombosis in lower extremities in group B,2 intramuscular venous thrombosis in lower extremities in group C,and 6 intramuscular venous thrombosis in group D.There was a significant difference between group A and group D.All patients with lung cancer had no clinical signs of venous thromboembolism.There were no significant differences in preoperative thrombelastographic parameters,and R values were significantly different between the postoperative groups.There was no significant difference in postoperative chest volume and bleeding-related complications between the 4 groups of lung cancer patients.Conclusion:The use of low-molecular-weight heparin calcium prophylactic anticoagulation therapy can significantly reduce the risk of venous thrombosis at 12 h after lung cancer surgery,and it is better than anticoagulation therapy initiated at 24 h and 48 h.
引文
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[19] Salla E,Dimakakos EP.Venous thromboembolism in patients diagnosed with lung cancer[J].Angiology,2016,67(8):709-724.
[20] Zhang X,Huang YG,Yu XR.The effect of sex,age and body mass index on coagulation function in patients with r-TEG[J].Chin J Blood Transfusion,2014,27(3):288-290.[张雪,黄宇光,虞雪融.手术患者性别,年龄及体重指数对r-TEG所示凝血功能的影响[J].中国输血杂志,2014,27(3):288-290.]
[21] Zeng YL,Gao F,Wei JF.Value of thromboelastography in evaluating coagulation function and prognosis in patients with acute-on-chronic liver failure[J].Chin J Hepatol,2017,25(1):32-37.[曾艳丽,高飞,魏君峰.血栓弹力图评价慢加急性肝衰竭患者的凝血功能及预后研究[J].中国肝脏病杂志,2017,25(1):32-37.]
[2] Wang J,Zhang X.Risk factors,mechanism and laboratory testing of hypercoagulable state in patients with malignant tumor[J].Lab Med Cli,2015,12(15):2284-2287.[王静,张霞.恶性肿瘤患者高凝状态的危险因素、发生机制及实验室检测[J].检验医学与临床,2015,12(15):2284-2287.]
[3] Mryer G.Venous thromboembolism and cancer[J].Rev Pnoumol Clin,2014,70(1-2):91-94.
[4] Lyman GH,Culakova E,Poniowerski MS,et al.Morbidity,mortality and costs associated with venous thromboembolism in hospitalized patients with cancer[J].Thromb Res,2018,4(1):s112-s118.
[5] Boonyawat K,Crowther MA.Venous thromboembolism prophylaxis incritically ill patients[J].Semin Thromb Hemost,2015,41(1):68-74.
[6] Song JQ,Xuan LZ,Wu W,et al.Low molecular weight heparin once versus twice for thromboprophylaxis following esophagectomy:A randomised,double-blind and placebo-controlled trial[J].Thorac Dis 2015,7(7):1158-1164.
[7] Monreal M,Mahe I,Bura-Riviere A,et al.Pulmonary embolism:Epidemiology and registries[J].Presse Med,2015,12(44):e377-383.
[8] Tesselaar ME,Osanto S.Risk of venous thromboembolism in lung cancer[J].Cucc Opin Pulm Med,2007,13(5):362-367.
[9] Ohashi Y,Ikeda M,Kunitoh H,et al.Venous thromboembolism in patients with cancer:Design and rationale of a multicentre,prospective registry(Cancer-VTE registry)[J].BMJ Open,2018,8(5):e18910.
[10] Guha Alai,Deng Hanyu,Li Gang,et al.The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery[J].J Thorac Dis,2018,4(4):2288-2294.
[11] Streiff MB.National Comprehensive Cancer Center Network.The national comprehensive cancer center network(NCCN) guidelines on the management of venous thromboembolism in cancer patients[J].Thrombo Res,2010,125(Suppl 2):S128-S133.
[12] Virchow R. Cellular pathology. As based upon physiological and pathological histology. Lecture XVI-Atheromatous affection of arteries 1858[J].Nutr Rev,1989,47(1):23-25.
[13] Seth R,Tai LH,Falls T,et al.Surgical stress promotes the development of cancer metastases by a coagulation-dependent mechanism involving natural killer cells in a murine model[J].Ann Surg,2013,258(1):158-168.
[14] Xu CC,Fu XN.The changes of blood coagulation in surgical patients with lung cancer[J].Chin J Lung Cancer,2010,13(2):136-139.[徐澄澄,付向宁.肺癌患者手术前后凝血状态的变化[J].中国肺癌杂志,2010,13(2):136-139.]
[15] Deng HY,Shi CL,Li G,et al.The safety profile of preoperative administration of heparin for thromboprophylaxis in Chinese patients intended for thoracoscopic major thoracic surgery:A pilot randomized controlled study[J].Thorac Dis 2017,9:1065-1072.
[16] Corrales-Rodriguez L,Blais N.Lung cancer associated venous thromboembolic disease:A comprehensive review[J].Lung Cancer,2012,75(1):1-8.
[17] Gras J.Semuloparin for the prevention of venous thromboembolic events in cancer patients[J].Drugs Today,2012,48:451-457.
[18] Gould MK,Garcia DA,Wren SM,et al.Prevention of VTE in non orthopedic surgical patients:Antithrombotic therapy and prevention of thrombosis,9th ed:American college of chest physicians evidence-based clinical practice guidelines[J].Chest,2012,141(2):e227S-e277S.
[19] Salla E,Dimakakos EP.Venous thromboembolism in patients diagnosed with lung cancer[J].Angiology,2016,67(8):709-724.
[20] Zhang X,Huang YG,Yu XR.The effect of sex,age and body mass index on coagulation function in patients with r-TEG[J].Chin J Blood Transfusion,2014,27(3):288-290.[张雪,黄宇光,虞雪融.手术患者性别,年龄及体重指数对r-TEG所示凝血功能的影响[J].中国输血杂志,2014,27(3):288-290.]
[21] Zeng YL,Gao F,Wei JF.Value of thromboelastography in evaluating coagulation function and prognosis in patients with acute-on-chronic liver failure[J].Chin J Hepatol,2017,25(1):32-37.[曾艳丽,高飞,魏君峰.血栓弹力图评价慢加急性肝衰竭患者的凝血功能及预后研究[J].中国肝脏病杂志,2017,25(1):32-37.]