慢性高血压并发子痫前期术后早期应用那屈肝素钙对血栓形成的影响研究  

Study on the effect of early application of Nadroparin Calcium on thrombus formation in cesarean section of preeclampsia superimposed upon chronic hypertension

作　　者：郑秀芬 钟少平[1] 沈华祥[1] 刘霞[1] 朱小玉[1] ZHENG Xiufeng;ZHONG Shaoping;SHEN Huaxiang;LIU Xia;ZHU Xiaoyu(Department of obstetrics and gynecology, jiaxing college affiliated maternity and child care hospital,Jiaxing 314015,China)

机构地区：[1]嘉兴学院附属妇幼保健院妇产科,浙江嘉兴314015

出　　处：《中国现代医生》2017年第31期49-52,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2017KY655)

摘　　要：目的评价术后不同时机那屈肝素钙皮下注射对慢性高血压并发子痫前期血栓形成的影响。方法选取因慢性高血压并发子痫前期行剖宫产术患者36例,将其随机分为观察组与对照组两组,各18例。观察组的患者术后6 h即行那屈肝素钙抗凝治疗,对照组的患者术后第2天行抗凝治疗。抽取两组患者肘静脉血样,分别选取于入室开放静脉后(T_0)、术毕(T_1)、术后的6 h(T_2)及术后的24 h(T_3),检测血红蛋白(Hb)、血细胞比容(HCT)、凝血功能指标及血液流变学变化指标。用彩色多普勒超声于术前1d及术后7 d检测两组患者双下肢深静脉通畅情况。结果较T_0,T_2时两组患者Hb和HCT均明显降低(P<0.05)。较T_0,T_2及T_3时的两组全血黏度的高切变率、全血黏度低切变率和血浆黏度均降低;T_3时观察组D-二聚体降低(P<0.05)。两组患者术后均无皮下瘀斑等出血征象,两组患者术后药物不良反应发生率无明显差异(P>0.05)。术后5 d时,对照组出现一例下肢深静脉血栓形成(DVT),DVT发生率5.56%,观察组无DVT发生。观察组DVT发生率低于对照组(P<0.05)。结论术后早期应用那屈肝素钙能改善患者术后血液流变学状态,降低发生深静脉血栓形成的危险。Objective To investigate the effect of early application of Nadroparin Calcium on thrombus formation in preeclampsia superimposed upon chronic hypertension after cesarean section.Methods Thirty-six patients with preeclampsia superimposed upon chronic hypertension undergoing cesarean section were randomLy divided into2groups(n=18each group):observation group and control group.Patients in observation group obtained Nadroparin Calcium at six hours after the operation,and the other patients received anticoagulation therapy at the second day of post-operation.Venous blood samples were collected After entering the operating room,open the venous before opertation(T0),the end of the operation(T1),at six hours after the operation(T2)and the first day of post-operation(T3)for measurement of hemoglobin(Hb),hematocrit(HCT),coagulation function and hemorheology.The deep veins of lower limb were tested by color Doppler ultrasound at the day preoperative and the seventh day post-operation.Results The Hb and HCT significantly decreased in two groups at T2than at T0(P<0.05).Low or high shear rates and plasma viscosity were significantly decreased at T2and T3than T0in observation group,D-dimer was decreased at T3than that in control group(P<0.05).There were no subcutaneous ecchymosis and other signs of bleedin in two groups,and there were no significant difference between the two groups(P>0.05).On the5day after surgery,a case of deep vein thrombosis(DVT)occurred in the control group,the incidence of DVT was5.56%,and no DVT was observed in the observation group.The incidence of DVT in the observation group was lower than that in control group(P<0.05).Conclusion Early application of Nadroparin Calcium post operative can improve postoperative hemorrheological situation and decrease the rate of the deep vein thrombosis.

关 键 词：慢性高血压并发子痫前期 手术治疗 静脉血栓形成 那屈肝素钙 

分 类 号：R714.2[医药卫生—妇产科学]