预防性抗凝对乳腺癌患者经外周静脉穿刺中心静脉置管后深静脉血栓形成的作用研究  

Preventive effect of anticoagulant therapy on deep vein thrombosis after peripherally inserted central catheter in patients with breast cancer

作　　者：高芳宁[1] 郭松林[1] 商芳 杨媛[1] 阴继凯[1] 王磊[1] 张章[1] GAO Fang-ning, GUO Song-lin, SHANG Fang, YANG Yuan, YIN Ji-kai, WANG Lei, ZHANG Zhang.(Department of General Surgery, Tangdu Hospital Affiliated to the Fourth Military Medical University, Xi＇an 710038, Chin)

机构地区：[1]第四军医大学附属唐都医院普通外科,西安710038

出　　处：《中国血管外科杂志（电子版）》2018年第1期35-37,共3页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的对照那屈肝素评估利伐沙班对乳腺癌患者外周静脉穿刺中心静脉置管(PICC)置管后并发深静脉血栓形成(DVT)的预防作用。方法选取接受PICC置管的乳腺癌患者78例,化疗期间未使用任何抗凝药物的作为对照组(n=21),PICC置管后使用抗凝药物者分为利伐沙班组(n=32)和那屈肝素组(n=25)。利伐沙班组和那屈肝素组根据D-二聚体是否大于1μg/ml,分别分为D-二聚体>1μg/ml组和D-二聚体<1μg/ml组。抗凝预防治疗疗程均为15 d。结果对照组有2例发生DVT,发生率为9.5%,而PICC置管后使用抗凝药物的两组,D-二聚体>1μg/ml组和D-二聚体<1μg/ml组均未发生DVT。使用抗凝药组与对照组相比,DVT发生率显著降低(χ2=5.83,P<0.05)。那屈肝素组发生1例皮下出血,利伐沙班组无出血并发症发生。结论利伐沙班和那屈肝素均可以显著降低乳腺癌患者PICC置管后并发DVT的发生率,利伐沙班相对更加方便、安全。Objective To evaluate the preventive effect of rivaroxaban and nadroparin for the anticoagulant therapy on deep vein thrombosis after peripherally inserted central catheter（PICC） in patients with breast cancer. Methods The clinical data of 78 patients with breast cancer receiving PICC were analyzed retrospectively. The control group（n=21） did not use any anticoagulant drugs during the chemotherapy, while patients using anticoagulant drugs were divided into rivaroxaban group（n=32） and nadroparin group（n=25）.Rivaroxaban and nadroparin group were divided into D-dimer 1μg/ml group and D-dimer 1μg/ml group according to the D-dimer content. The two PICC groups took anticoagulant prophylaxis regimens for 15 days. Results Two cases occurred deep vein thrombosis in the control group, the incidence rate was 9.5%.No deep venous thrombosis occurred in the two PICC groups after the use of anticoagulant drugs, no matter the D-dimer is greater than 1μg/ml or not. The incidence of deep venous thrombosis was significantly reduced in the group of using anticoagulant therapy comparing with the control group（ χ2=5.83, P〈0.05）.1 cases occurred subcutaneous hemorrhage in nadroparin group. No bleeding complications occurred in the rivaroxaban group. Conclusion The incidence of deep venous thrombosis in patients with breast cancer af ter PICC was significantly reduced by using anticoagulant drugs. Compared to nadroparin, rivaroxaban seems to be more convenient and safely.

关 键 词：外周静脉穿刺中心静脉置管 深静脉血栓 D-二聚体 利伐沙班 那屈肝素 

分 类 号：R737.9[医药卫生—肿瘤]