大隐静脉曲张合并肌间静脉增宽患者术后抗凝的疗效分析  

The effects of unfraction heparin or low molecular weight heparin anticoagulant therapy on coagulation related factors in patients with great saphenous varicosis veins and muscular venous widening after surgery

作　　者：雷勇[1] 赵宁[2] 杨进强[1] 尹长恒[2] 贾巍[1] LEI Yong;ZHAO Ning;YANG Jinqiang(Department of General Surgery,Harrison International Peace Hospital,Hebei,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院普外一科,河北省衡水市053000 [2]哈励逊国际和平医院妇科,河北省衡水市053000

出　　处：《河北医药》2018年第22期3425-3428,共4页Hebei Medical Journal

基　　金：衡水市科技创新局项目(编号:2017014013C-08)

摘　　要：目的研究合并肌间静脉增宽的大隐静脉曲张患者术后非肝素或低分子肝素(LMWH)抗凝治疗对凝血相关因子的影响及防治效果。方法大隐静脉高位结扎术治疗的110例合并肌间静脉增宽的大隐静脉曲张患者,按随机数字表法将患者分为LMWH组(n=54)和非LMWH组(n=56),非LMWH组患者给予常规扩血管治疗,LMWH组患者在对照组基础上给予低分子肝素钙,治疗1周后观察2组患者凝血相关因子及凝血功能指标[血管性血友病因子(v WF)、组织纤溶酶原激活物(t-PA)、纤溶酶原液激活物抑制物(PAI-1)、血小板P-选择素(GMP-140)和D二聚体(D-D)、血红蛋白、活化部分凝血酶时间(a PTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)],同时观察记录2组患者术后并发症发生情况及下肢深静脉血栓形成发生率和比较术后1年随访调查结果。结果术后3、7 d LMWH组患者在血浆中v WF、t-PA、PAI-1、GMP-140和D-D水平显著低于非LMWH组(P <0. 05),而术后3、7 d 2组患者在血红蛋白、APTT、PT、Fib、红细胞计数及术后并发症比较差异无统计学意义(P> 0. 05)。与非LMWH组比较,LMWH组患者下肢深静脉血栓形成发生率显著降低(P <0. 05),且LMWH组患者术后1年下大隐静脉曲张复发率和隐神经损伤发生率明显低于非LMWH组,差异有统计学意义(P <0. 05)。结论低分子肝素对于大隐静脉曲张患者术后下肢深静脉血栓的形成具有良好预防效果,疗效安全,值得临床推广使用。Objective To observe the effects of unfraction heparin or low molecular weight heparin(LMWH)anticoagulant therapy on coagulation related factors in patients with great saphenous varicosis veins and muscular venous widening after surgery.Methods A total of 110 patients with muscular venous widening after high ligation of great saphenous vein who were treated in our hospital from January 2013 to February 2015 were enrolled in the study.According to random digital table,these patients were randomly divided into LMWH group(n=54)and non-LMWH group(n=56).The patients in non-LMWH group were treated by conventional vasodilator therapy,however,thepatients in LMWH group,on the basis of control group,were treated by LMWH.After 1-week treatment,the coagulation related factors and coagulation function indexes were observed,and the incidence rates of postoperative complications and lower extremity deep vein thrombosis and the follow-up results were observed and compared between the two groups.Results The plasma levels of vWF,t-PA,PAI-1,GMP-140 and D-D at 3 days and 7 days after surgery in LMWH group were significantly lower than those in non-LMWH group(P<0.05),however,there were no significant differences in the levels of,APTT,PT,Fib,hemoglobin,red blood cell count and postoperative complications at 3 days and 7 days after surgery between the two groups(P>0.05).Moreover the incidence of lower extremity deep venous thrombosis and recurrence rate of great saphenous varicosis veins in LMWH group were significantly lower than those in non-LMWH group(P<0.05).Conclusion The low molecular weight heparin has good prevention effects on lower extremity deep venous thrombosis in patients with great saphenous varicose veins after surgery,with good safety,therefore,it is worthy of clinical application and promotion.

关 键 词：大隐静脉曲张 肌间静脉增宽 低分子肝素 抗凝治疗 凝血相关因子 血栓预防 

分 类 号：R543.6[医药卫生—心血管疾病]