脾切除断流术后早期抗凝治疗对患者凝血功能的影响  

Early anticoagulation therapy after splenectomy plus devascularization in the prevention of thrombosis

作　　者：张秋学[1] 张执全[1] 刘汝海[1] 王铁功[1] 张磊[1] 陈新[1] 

机构地区：[1]河北省沧州市中心医院普外一科,061001

出　　处：《中华普通外科杂志》2014年第8期634-636,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨脾切除断流术后早期抗凝治疗对患者凝血功能的影响.方法 回顾性分析脾切除断流术后早期开始抗凝治疗106例患者的临床资料,术后24h开始应用低分子右旋糖酐500 ml＋川芎嗪160 mg,持续1周,术后48 h再加用低分子肝素钙4 250 ～4 500 U每12h皮下注射1次,持续7 ～14d,术后3、5、7、10、14d检测凝血项.每周1～2次超声检查,了解门静脉系统血栓情况,严密观察切口和腹腔出血情况.结果 血栓发生率为7.5％（8/106）,部分凝血活酶时间（APTT）在用药7 ～14d后延长最为明显,其次为凝血酶原时间（PT）和凝血酶时间（TT）延长,纤维蛋白原（FIB）减少,但与正常值比较,各项指标的变化均无统计学意义.患者未发生明显的出血并发症.结论 脾切除断流术后早期应用低分子肝素钙抗凝治疗对凝血指标有一定影响,但是无相关出血并发症发生,因此早期抗凝安全可行.Objective To explore the effect of early anticoagulation therapy on the blood coagulation in patients undergoing splenectomy plus devascularization.Methods Clinical data of 106 patients in Cangzhou Central Hospital from June 2000 to December 2012 were reviewed.Beginning 24 h after surgery,low molecular dextran 500 ml ＋ ligustrazine 160 mg,once a day for 1 week,and after 48 h low molecular heparin calcium at 4 250 U to 4 500 U was given every 12 h for 7 to 14 d.Blood coagulation was tested on day 3,5,7,10 and 14,ultrasound 1-2 times a week was taken for detection of portal venous thrombosis.Results The incidence of portal thrombosis was 7.5％ （8/106）.APTT prolonged during 7-14 d.Prothrombin time （PT）,thrombin time （TT） and fibrinogen （FIB） decreased,but all the changes were not statistically significant when compared with the normal values（P ＞0.05）.Anticoagulant treatment did not cause bleeding complications in this series.Conclusions Postoperative application of low molecular heparin calcium anticoagulant therapy is effective in the prevention of portal thrombosis and safe in terms of coagulation when started early in patients undergoing splenectomy.

关 键 词：高血压 门静脉 静脉血栓形成 抗凝药 凝血指标 

分 类 号：R657.6[医药卫生—外科学]