腰椎后路减压固定术后低分子肝素抗凝的安全性和有效性  

Postoperative efficiency and safety of different regimens of low molecular weight heparin on lumbar posterior decompression and fixation

作　　者：罗科锋[1] 蒋国强[1] 卢斌[1] 叶一[1] 岳兵[1] 韩成钢[1] 陆继业[1] 史超路[1] 

机构地区：[1]宁波大学医学院附属医院脊柱外科,315020

出　　处：《中华骨科杂志》2015年第11期1111-1116,共6页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生平台计划（重点资助）（2014ZDA020）

摘　　要：目的 探讨腰椎后路减压固定术后低分子肝素抗凝治疗不同使用方法的有效性和安全性。方法 2010年8月至2012年3月358例行腰椎后路减压固定手术的腰椎退变疾病或腰椎骨折患者按照术中出血量分为三组：少量失血组（72例）, 术中失血量≤ 300 ml, 术后12 h应用抗凝药物；中等失血组（247例）, 术中失血量300~500 ml, 术后24 h使用抗凝药；大量失血组（39例）, 术中失血量≥500 ml, 术后36 h应用抗凝药物。术后应用低分子肝素（low molecular weight heparin, LMWH）0.3 ml, 每日1次, 皮下注射, 连续7 d。记录三组患者吸烟史、高血压病、糖尿病等合并症情况, 统计术后深静脉血栓（deep vein thrombosis, DVT）、肺栓塞（pulmonary embolism, PE）及出血性事件的发生情况, 分析吸烟、高血压病、糖尿病等危险因素对术后静脉血栓栓塞（venous thrombus embolism, VTE）和出血相关疾病发生率的影响。结果 术后27例发生VTE, 平均年龄62岁, 体质指数平均为26.3 kg/m^2；其中10例有吸烟史, 12例有高血压病史, 8例有糖尿病史。少量失血组中发生1例DVT, VTE发生率为1.39%；中等失血组中19例发生DVT及2例发生PE, VTE发生率为8.50%；大量失血组中4例发生DVT及1例发生PE, VTE发生率为12.82%。术后并发硬膜外血肿、血尿、黑便等出血性事件共12例（3.35%）, 少量失血组3例（4.17%, 3/72）、中等失血组7例（2.83%, 7/247）、大量失血组2例（5.13%, 2/39例）。结论 术后12 h初次应用LMWH, VTE发生率下降, 但出血性事件发生率未见明显升高；吸烟、高血压病、糖尿病均可增加术后VTE的发生。Objective To explore the postoperative efficiency and safety of different regimens of low molecular weight heparin for anticoagulant therapy on lumbar posterior decompression and fixation. Methods From August 2010 to March 2012, 358 patients with lumbar disc degeneration or lumbar fracture underwent posterior decompression and fixation were divided into three groups： minor bleeding group （72 cases）, blood loss ≤ 300 ml, anticoagulant drugs were applied 12 h postoperatively; moderate bleeding group （247 cases）, blood loss 300-500 ml, anticoagulant drugs were applied 24 h postoperatively; excessive bleeding group （39 cases）, blood loss ≥500 ml, anticoagulant drugs were applied 36 h postoperatively. Low molecular weight heparin （LMWH） was dosed as 0.3ml per day, 7 days consecutively. Smoking history, hypertension and diabetes were recorded, and postoperative deep vein thrombosis （DVT）, pulmonary embolism （PE） and hemorrhage-related diseases were collected among the 3 groups, respectively. In addition, the association between the risk factors and occurrence rate of postoperative DVT, PE and hemorrhage-related diseases was analyzed. Results Twenty-seven patients suffered from venous thrombus embolism （VTE）, in which 10 patients had smoking history, 12 patients had hypertension history, and 8 patients had diabetes history. The average age was 62 years old; the average body mass index was 26.3 kg/m2. In the minor bleeding group, 1 patient suffered from DVT, and the incidence rate of VTE was 1.39%; in the moderate bleeding group, 19 patients suffered from DVT, 2 patients suffered from PE, and the incidence rate of VTE was 8.50%; in the excessive bleeding group, 4 patients suffered from DVT while 1 patient suffered from PE, so the incidence rate of VTE was 12.82%. There are 12 patients suffered from postoperative hemorrhage-related diseases, including epidural hematoma, hematuria and melena, including 3 patients （4.17%, 3/72） in the minor bleeding group; 7 patients （2.83%, 7/247）

关 键 词：腰椎 脊柱融合术 静脉血栓形成 肝素  低分子量 出血 

分 类 号：R687.3[医药卫生—骨科学]