有高危因素的妇科手术患者预防性血栓治疗的临床意义  

Clinical significance of preventive treatment of thrombosis for patients undergoing gynecological surgery with high risk factors

作　　者：杨柏柳[1] 张震宇[1] 郭淑丽[1] 

机构地区：[1]首都医科大学附属北京朝阳医院妇产科,100020

出　　处：《中华妇产科杂志》2009年第8期570-573,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：基金项目：首都医学发展科研基金（2005-1005）

摘　　要：目的探讨对有高危因素的妇科手术患者进行预防性血栓治疗的临床意义。方法采用前瞻性随机对照研究的方法，将2005年9月1日～2006年2月28日问在北京朝阳医院住院的143例有高危因素的妇科手术患者随机分为问歇性气囊加压（IPC）组（47例）、低分子肝素（LMWH）组（48例）和对照组（48例，无预防措施），对下肢深静脉血栓（LDVT）的预防效果及安全性进行比较，并分析影响LDVT预防效果的相关因素。结果IPC组患者LDVT的患肢发生率为6％（6／94），LMWH组为1％（1／96），对照组为18％（17／96），IPC组和LMWH组均明显低于对照组（P〈0．05）；而IPC组与LMWH组比较，差异则尢统计学意义（P〉0．05）。对照组发现LDVT的时间以术后3～4d时最多，为12条下肢；ICP组以术后5d时最多，为4条下肢；LMWH组仅1条下肢发生LDVT，于术后5d时发现。IPC组术后3～4d时LDVT的发生率为1／6，LMWH组为0，对照组为71％（12／17），IPC和LMWH组明显低于对照组（P〈0．05）。IPC组患者预防性血栓治疗后无不良反应发生；LMWH纽仅1例术后阴道残端出现少量出血，尤手术切口出血及出血倾向发生。单因素分析显示，高龄、开腹手术及恶性肿瘤为影响LDVT预防效果的相关困素（P〈0．05）。结论妇科手术后对有高危冈素的患者予预防性血栓治疗可以明显减少并延迟其术后LDVT的发生，且无明显不良反应发生；高龄、开腹手术及恶性肿瘤为影响LDVT预防效果的相关因素。Objective To explore the clinical significance of preventive treatment of thrombosis for patients undergoing gynecological surgeries with high risk factors. Methods Prospectively, randomized and cases controlled study was performed in 143 patients underwent gynecological surgery with high risk factors to explore the prevention effectiveness and safety in morbidity of lower extremity deep venous thrombosis （LDVT） and relative effected factors, who were enrolled to three groups according to different preventive treatment： group using intermittent pneumatic calf compression （IPC） in 47 cases, group using low- molecular-weight hepairin（LMWH） in 48 cases and control group in 48 cases with no prevention strategy. Results The morbidity of LDVT on lower extremity was 6% （6/94） in group IPC and 1% （ 1/96 ） in group LMWH, 18% （17/96）in control group, which was obviously reduced in group IPC and group LMWH than that in control group （ P 〈 0. 05 ） , while there was no significantly difference between group IPC and group LMWH（P 〉 0. 05）. After surgery in 3 or 4 days, the morbidity of LDVT in group IPC was 1/6,zero in group LMWH and 71% （12/17） in control group, there was significantly reduced in group IPC and group LMWH than that in control group （ P 〈 0. 05）. There was no side-effects in group IPC, only 1 ease in group LMWH presented small quantity bleed in vagina remnant, while no incision bleeding and bleed tendency. Singlevariate analysis indicated that elder age, abdominal surgeries and malignant tumor were as the independent factors to effect preventive treatment of thrombosis （ P 〈 0. 05 ）. Conclusion I,DVT in patients underwent gynecological surgeries with high risk factors can be obviously reduced and delayed by preventive treatment, which is no side-effects, while be effected by the factors of elder age, abdominal surgeries and malignant tumor.

关 键 词：静脉血栓形成 妇科外科手术 危险因素 事故预防 

分 类 号：R686[医药卫生—骨科学]