腹部肿瘤根治术后药物预防深静脉血栓治疗对全身炎症反应的临床影响  

Drug prophylaxis of deep vein thrombosis after radical operation of abdominal tumors ： the clinical effect to systemic inflammatory response syndrome

作　　者：贺梁[1] 王江[1] 南林[1] 林海[1] 张永久[1] 

机构地区：[1]兰州军区乌鲁木齐总医院普外科,830000

出　　处：《临床外科杂志》2013年第8期618-620,共3页Journal of Clinical Surgery

摘　　要：目的 总结腹部肿瘤规范化切除及清扫术后深静脉血栓（DVT）防治经验的同时,探讨不同方案对于术后全身炎症反应（SIRS）的影响.方法 对548例接受腹部肿瘤规范化切除及淋巴结清扫病例术后以不同方案应用低分子肝素、低分子右旋糖酐及丹参注射液防治血栓.回顾分析各组治疗方案对术后全身炎症反应几个重要指标的影响.结果 以术后5d内三项客观检验数均值：C-反应蛋白≥3 mg/L,降钙素原≥0.25 ng/ml,白细胞计数＞12×109/L作为阳性指标；以两项临床监测数值：体温＞ 37.8℃,腹腔引流液多于50 ml为临床观察阳性指标.经统计分析,不使用低分子肝素组患者与使用低分子肝素的另两组在术后全身炎症反应指标方面差异有统计学意义,而术后当日使用低分子肝素组患者与推迟使用低分子肝素组之间差异无统计学意义.但临床观察发现,推迟使用低分子肝素的第3组体温升高病例数减少且不会增加腹腔引流液量.结论 术后当日起应用低分子右旋糖酐及丹参注射液,术后第3天起加用低分子肝素不但对于预防腹部肿瘤根治术后DVT发生的效果较佳,且可以有效减少全身炎症反应的发生.Objective To summarize the prevention and treatment experience of deep vein thrombosis（DVT） after standardized radical operation and lymph node dissection of abdominal tumors and discuss the effect of different protocols on the postoperative systemic inflammatory response syndrome（SIRS）.Methods A total of 548 patients who received radical operation and standardized lymph node dissection for abdominal tumors were enrolled and treated with low molecular weight heparin（LMWH）,low molecular weight dextran（LMWD） or salvia miltiorrhiza injection for the prevention of DVT.Several important index of SIRS was compared and analyzed between the groups.Results The elevated C-reactive protein （≥ 3mg/L）,procalcitonin（≥0.25 ng/ml）,white blood cell（＞ 12 × 109/L） in 5 days after operation were regarded as positive objective indicators.Besides that,the increased body temperature（＞ 37.8℃C）and abdominal drainage（＞ 50 ml）were regarded as positive clinical indicators.The differences in SIRS indicators between the patients with and without LMWH treatment were significant.The delay of LMWH application did not influence the SIRS indicators significantly.The cases of fervescence were less and the intraperitoneal drainage did not increase in Group 3 after the delay of LMWH application.Conclusion It brings better effect in thrombosis prevention and reduction of SIRS after the operation by using salvia miltiorrhiza and LMWD on the day of surgery and LMWH on the third day after surgery.

关 键 词：深静脉血栓 全身炎症反应 

分 类 号：R619.2[医药卫生—外科学]