不同方法预防妇科腹腔镜手术患者静脉血栓栓塞的应用价值  

The value of different methods for prevention of venous thromboembolism for patients undergoing laparoscopic gynecological surgery

作　　者：郭伟平[1] 申沛[1] 林耀蕙[1] 朱芳芳[1] 王军[1] 刘勇战 

机构地区：[1]中国人民解放军第一五二中心医院妇产科,河南平顶山467000

出　　处：《重庆医学》2016年第30期4240-4242,共3页Chongqing medicine

摘　　要：目的探讨不同治疗方法对有高危因素的妇科腹腔镜手术患者预防静脉血栓栓塞(VTE)的临床应用价值。方法采用前瞻性对照研究方法,将2013年1月至2014年10月178例在该院住院期间有高危因素的妇科腹腔镜手术患者分为A、B、C组。A组64例患者术后12h应用低分子肝素(LMWH)5 000U,每日1次;B组64例患者术后12h应用LMWH 2 500U加丹参20mL,每日1次;C组50例患者术后未预防性应用上述药物。比较3组患者深静脉血栓形成(DVT)的发生率、术后出血情况及凝血指标变化。结果所有患者均在腹腔镜下成功完成手术,3组患者共发生下肢DVT 7例,术后出血9例。A、B、C组患者术后DVT发生率分别为0、1.6%和12.0%;A、B组分别与C组比较,差异均有统计学意义(P<0.05)。A、B、C组患者术后出血发生率分别为9.4%、3.1%和2.0%,A组与B、C组比较,差异有统计学意义(P<0.05)。A组患者血小板计数较术前下降,B、C组变化不大,A组分别与B、C组比较,差异均有统计学意义(P<0.05);A、B组血浆活化部分凝血活酶时间、凝血酶原时间均延长,与C组比较,差异均有统计学意义(P<0.05)。结论术后早期应用LMWH可明显降低有高危因素妇科腹腔镜患者术后VTE发生率,LMWH联合丹参可提高抗凝安全性,不增加术后出血等风险。Objective To investigate the clinical value of different methods for prevention of venous thromboembolism（VTE）for patients undergoing laparoscopic gynecological surgery with high risk factors.Methods Prospectively case controlled study was performed in 178 patients underwent laparoscopic gynecological surgery with high risk factors at the No.152 Central Hospital of PLA from January 2013 to October 2014.All patients were divided into group A,B and C.A total of 64 cases in group A received subcutaneous injection of LMWH（5 000 U,once a day）at 12 hours after operation.A total of 64 cases in group B were treated with LMWH（2 500 U,once a day）combined with Salvia miltiorrhiza（20mL,once a day）.A total of 50 cases in group C did not treated with prophylactic use of these drugs.The incidence of deep venous thrombosis（DVT）,postoperative bleeding in and coagulation changes were recorded and compared in the three groups.Results All patients were successfully operated with laparoscopy,among them,7cases were complicated with DVT and 9cases were complicated with postoperative bleeding.The incidence of postoperative DVT in group A,B and C was 0,1.6% and 12.0%respectively,the differences were statistically significant in group A and B compared with group C,respectively（P〈0.05）.The incidence of postoperative bleeding group A,B and C was 9.4%,3.1% and 2.0% respectively,the differences were statistically significant in group A compared with group B and C（P〈0.05）.After operation,the platelet count in group A decreased,however,that in group B and C changed little.The platelet count in group A was statistically different compared with group B and C（P〈0.05）.The plasma activated partial thromboplastin time and prothrombin time in group A and B were prolonged,the differences were statistically significant in group A and B compared with group C（P〈0.05）.Conclusion Early injection of LMWH after laparoscopic gynecological surgery in patients with high risk factors can significantly reduce the inciden

关 键 词：腹腔镜 血栓栓塞 静脉 预防 妇科外科手术 肝素 低分子量 丹参 

分 类 号：R713[医药卫生—妇产科学]