胸腔镜手术患者术前使用肝素防治血栓的安全性研究  

Safety of preoperative heparin for prevention of thrombus in patients undergoing thoracoscopic surgery

作　　者：孙平 汪路明[1] 徐俊[2] 王一青[1] 吕望[1] 胡坚[1] Sun Ping;Wang Luming;Xu Jun;Wang Yiqing;Lyu Wang;Hu Jian(Department of Thoracic Surgery,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Surgery,Hangzhou Third Hospital,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第一医院胸外科,杭州310003 [2]杭州市第三人民医院外科,杭州310009

出　　处：《中华危重症医学杂志（电子版）》2019年第4期245-249,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：“十三五”国家重点研发计划项目(2017YFC0113500);浙江省重大科技专项计划项目(2014C03032);“十三五”浙江省中医药(中西医结合)重点学科资助项目(2017-XK-A33)

摘　　要：目的探讨胸腔镜手术患者术前运用低分子量肝素(LMWH)预防血栓的安全性。方法选择2018年1月至2018年6月在浙江大学医学院附属第一医院接受胸腔镜手术的76例患者,采用简单随机法分为病例组(38例)和对照组(38例)。其中,每组各6例患者转为开放手术,最终每组各纳入32例。病例组在入院后正确启动12 500 IU LMWH进行预防,1次/d,并持续至出院;对照组从术后第1天开始皮下注射12 500 IU LMWH,1次/d,一直持续到出院。比较两组患者的一般资料、术后LMWH持续时间、操作时间、术中出血、术后血小板计数、术后国际标准化比率(INR)、术后引流时间及每日平均排水量等指标。结果胸腔镜手术患者中,病例组患者术前LMWH持续时间为(2.8±1.3)d,对照组术前不给予LMWH。病例组及对照组患者术后LMWH持续时间[(4.3±1.7)d vs.(4.5±2.2)d]、操作时间[(164±107)min vs.(133±69)min]、术中出血[(131±86)mL vs.(96±88)mL]、术后血小板计数[(188±69)×10^9/L vs.(169±31)×10^9/L]、术后INR[(1.03±0.11)vs.(1.00±0.09)]、术后引流时间[(3.6±1.6)d vs.(3.8±1.8)d]及每日平均排水量[(256±89)mL vs.(204±104)mL]比较,差异均无统计学意义(t=0.988、5.026、4.187、1.288、0.597、0.492、3.479,P=0.629、0.398、0.256、0.261、0.277、0.472、0.145)。结论对于胸腔镜手术的患者,术前应用LMWH进行血栓预防是安全可行的。Objective To evaluate the safety of preoperative low molecular weight heparin(LMWH)for the prevention of thrombus in patients undergoing thoracoscopic surgery.Methods Betwwen January 2018 and June 2018,76 patients undergoing thoracoscopic surgery in the First Affiliated Hospital,College of Medicine,Zhejiang University were randomly divided into the case group(38 cases)and control group(38 cases).Among them,6 patients in each group were converted to open surgery,and 32 patients were included in each group finally.For patients in the case group,12 500 IU of LMWH was correctly used after admission once a day,and lasted untildischarge.Patients in the control group were injected subcutaneously with 12 500 IU of LMWH once a day from the first day after operation to discharge.General data,duration of postoperative LMWH,operating time,intraoperative bleeding,postoperative platelet count,postoperative international normalized ratio(INR),postoperative drainage time,and daily mean drainage betwwen two groups were compared.Results For patients undergoing thoracoscopic surgery,the duration of preoperative LMWH was(2.8±1.3)d in the case group,and no LMWH was given before the operation in the control group.The duration of postoperative LMWH[(4.3±1.7)d vs.(4.5±2.2)d],operating time[(164±107)min vs.(133±69)min],intraoperative bleeding[(131±86)mL vs.(96±88)mL],postoperative platelet count[(188±69)×10^9/L vs.(169±31)×10^9/L],postoperative INR[(1.03±0.11)vs.(1.00±0.09)],postoperative drainage time[(3.6±1.6)d vs.(3.8±1.8)d]and daily mean drainage[(256±89)mL vs.(204±104)mL]were not significantly different between the case group and control group(t=0.988,5.026,4.187,1.288,0.597,0.492,3.479;P=0.629,0.398,0.256,0.261,0.277,0.472,0.145).Conclusion For patients undergoing thoracoscopic surgery,it is safe and feasible to use LMWH for preventing thrombus before operation.

关 键 词：肝素 低分子量 术前 术后 血栓预防 安全 

分 类 号：R47[医药卫生—护理学]