下肢静脉曲张术后深静脉血栓形成原因分析及预防性应用低分子肝素的研究  

Causes of Deep Venous Thrombosis and Prophylactic Use of Low-Molecular-Weight Heparin after Surgery for Lower Extremity Varicosities

作　　者：王涛[1] 张立洪[1] 孙思磊[1] 邱晶晶[1] 李杰[1] 

机构地区：[1]扬州大学医学院附属泰兴市人民医院血管外科,江苏泰兴225400

出　　处：《实用临床医学（江西）》2014年第10期27-30,共4页Practical Clinical Medicine

摘　　要：目的探讨下肢静脉曲张手术(VVS)后下肢深静脉血栓形成(DVT)的原因,并观察使用低分子肝素后的预防效果。方法将575例下肢静脉曲张患者按入院时间的不同分为2组,2010年5月至2013年10月入院行VVS术后预防性使用低分子肝素者为LMWH组(285例),2008年1月至2010年4月入院行VVS术后未使用低分子肝素者为非LMWH组(290例)。观察2组患者DVT的发生及术后切口或(和)皮下瘀血、下肢肿胀或(和)疼痛情况,同时进行术前和术后5 d血小板计数(PLT)、凝血功能[凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FG)、活化部分凝血酶时间(APTT)]及D-二聚体(D-dimer)检测;术后随访1个月,再次检测D-dimer并观察其变化。结果非LMWH组发生DVT 12例(80.0%),LMWH组发生DVT 3例(20.0%),2组DVT发生率比较差异有统计学意义(P<0.05)。非LMWH组发生切口或(和)皮下瘀血、下肢肿胀或(和)疼痛分别为24、36例,LMWH组发生切口或(和)皮下瘀血、下肢肿胀或(和)疼痛分别为20、28例,2组比较差异无统计学意义(P>0.05)。糖尿病、年龄≥60岁、心脑血管疾病、既往有下肢血栓史、长期口服激素类药物及CEAP分类≥Ⅳ级均是下肢静脉曲张术后并发深静脉血栓形成的主要危险因素。2组术前、术后各时间点的PLT、凝血功能指标(PT、TT、FG、APTT)及D-dimer变化的比较差异均无统计学意义(均P>0.05)。结论原发糖尿病、高龄、心脑血管疾病、既往有血栓史、长期口服激素类药物等是下肢静脉曲张术后并发深静脉血栓的主要危险因素;预防性应用低分子肝素能有效地降低VVS术后DVT,且临床应用是相对安全的。Objective To explore the causes of deep venous thrombosis（DVT） after lower extremity varicose vein surgery（VVS）, and to observe the efficacy of low-molecular-weight heparin（LMWH） in the prevention of DVT. Methods A total of 575 patients with lower extremity varicosities were divided into two groups： LMWH group（patients were admitted to hospital between May 2010 and october 2013 and were given LMWH after VVS, n=285） and non-LMWH group（patients were admitted to hospital between January 2008 and April 2010 but were not given LMWH after VVS, n=290）. The incidences of DVT and postoperative incisional or/andsubcutaneous blood stasis and lower limb swelling or/and pain were observed in both groups. Platelet count（PLT）, prothrombin time（PT）, thrombin time（TT）, fibrinogen（FG）, activated partial thromboplastin time（APTT） and D-dimer were measured before and after operation. The levels of D-dimer were determined again 1 month after operation. Results The incidence of DVT in non-LMWH group（80.0%） was significantly higher than that in LMWH group（20.0%）（P〈0.05）.The incisional or/andsubcutaneous blood stasis and lower limb swelling or/and pain respectively occurred in 24 and 36 patients in non-LMWH group, and in 20 and 28 patients in LMWH group. The differences were not significant between the two groups（P〈0.05）. The main risk factors for DVT included diabetes,60 years of age and older, cardio-cerebral vascular disease, history of lower limb thrombosis, long-term oral hormonal drugs, and CEAP classification≥Ⅳ. There were no significant differences in PLT, PT, TT,FG, APTT and D-dimer between the two groups before and after operation（P〈0.05）. Conclusion Primary diabetes, advanced age, cardio-cerebral vascular disease, history of thrombosis and long-term oral hormonal drugs are the main risk factors for DVT after VVS. The LMWH is effective and safe in the prevention of DVT.

关 键 词：下肢静脉曲张手术 深静脉血栓形成 低分子肝素 

分 类 号：R543.6[医药卫生—心血管疾病]