低分子肝素预防脑出血后深静脉血栓有效性和安全性研究  

Efficacy and Safety Study on Low Molecular Heparin in the Prevention for Venous Thromboembolism Prophylaxis after Spontaneous Intracerebral Hemorrhage

作　　者：倪杰 钱健 王路娜[1] 王芳[1] 沙杜鹃[1] NI Jie;QIAN Jian;WANG Lu-Na;WANG Fang;SHA Du-Juan.(Department of Emergency, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属南京鼓楼医院急诊医学科,南京210008

出　　处：《中国卒中杂志》2018年第6期562-566,共5页Chinese Journal of Stroke

基　　金：南京市医学科技发展项目(YKK15070)

摘　　要：目的评估自发性脑出血(spontaneous intracerebral hemorrhage,sICH)患者早期皮下注射低分子肝素(low molecular weight heparin,LMWH)预防深静脉血栓形成(deep vein thrombosis,DVT)的有效性。方法共104例急性sICH患者纳入研究,其中LMWH组51例,对照组53例。LMWH组在入院后第4天开始,连续7 d皮下注射低分子肝素0.4 ml/d;对照组相对应给予下肢间断充气加压(intermittent pneumatic compression,IPC)措施。两组患者均于入院当天及LMWH治疗第7天检测溶血磷脂酸(lysophosphatidic acid,LPA)水平及抗凝血因子Ⅹa活性,并观察患者有无出血征象。结果治疗期间所有患者均未出现颅内血肿扩大及再出血事件,与对照组比较,治疗后LMWH组LPA水平(11.74±5.30)ng/ml明显低于对照组(26.81±5.12)ng/ml,比较差异具有统计学意义(P<0.05)。治疗后LMWH组抗凝血因子Xa活性(25.96±7.97)ng/ml明显较对照组(8.06±1.32)ng/ml增高,比较差异具有统计学意义(P<0.05)。结论急性sICH住院患者为DVT的高发人群,sICH患者在急性期皮下注射低剂量LMWH预防DVT是有效和安全的。Objective To assess the efficacy of low molecular weight heparin（LMWH） for deep vein thrombosis（DVT） in patients with spontaneous intracerebral hemorrhage（sICH） during early stage.Methods One hundred and four patients with sICH were enrolled in our study： LMWH group（n=51） and control group（n=53）. The patients of LMWH group were injected hypodermically with LMWH（Enoxaparin Sodium Injection, 0.4 ml/d） from day 4 th to day 10 th after admittance. While the patients in control group received intermittent pneumatic compression（IPC）. The LPA and the anticoagulant factor Xa level were detected on admission day and the treatment of low molecular heparin for the 7 th day in all patients, and whether the patient had bleeding signs were observed.Results No hematoma enlargement were observed in both groups. After treatment, the serum level of LPA were significantly lower in LMWH group than that of the control group（11.74±5.30 ng/ml vs26.81±5.12 ng/ml, P〈0.05）. The level of anti-Xa were significantly higher in LMWH group than that of the control group（25.96±7.97 ng/ml vs 8.06±1.32 ng/ml, P〈0.05）.Conclusion The hospitalized patients with acute sICH were the crowd with high risk of DVT. LMWH in doses of 0.4 ml once daily during acute phase in patients with sICH is safe and efficient.

关 键 词：自发性脑出血 深静脉血栓形成 低分子肝素 溶血磷脂酸 抗凝血因子Xa 

分 类 号：R743.34[医药卫生—神经病学与精神病学]