低分子肝素对实验兔PICC相关性血栓抑制作用的研究  

Inhibitory effect of low molecular weight heparin on catheter-related thrombosis with a peripherally inserted central catheter in rabbits

作　　者：黄利全[1] 梁淑霞[2] 陈黎[1] 陈桂园[1] 胡波 褚晓峰[4] HUANG Liquan;LIANG Shuxia;CHEN Li;CHEN Guiyuan;HU Bo;CHU Xiaofeng(Jinhua Polytechnic,Jinhua 321017,China;Jinhua Municipal Central Hospital,Jinhua 321000;JinHua People’s Hospital,Jinhua 321000;Zhejiang Academy of Medical Sciences,Hangzhou 310013)

机构地区：[1]金华职业技术学院,浙江金华321017 [2]金华市中心医院,浙江金华321000 [3]金华市人民医院,浙江金华3210002 [4]浙江省医学科学院,杭州310013

出　　处：《中国比较医学杂志》2020年第10期78-84,共7页Chinese Journal of Comparative Medicine

基　　金：金华市科技计划项目(2017-4-047)。

摘　　要：目的探讨不同浓度低分子肝素对PICC相关性血栓(catheter related thrombosis,CRT)形成的抑制作用。方法将40只实验兔按随机数字表法分为A组(对照组)、B组(低浓度低分子肝素组)、C组(中浓度低分子肝素组)、D组(高浓度低分子肝素组),成功建立PICC实验兔模型后,分别用0.9%氯化钠溶液、50μ/(mL·d)低分子肝素钠溶液、100μ/(mL·d)低分子肝素钠溶液、200μ/(mL·d)低分子肝素钠溶液在实验兔腹部进行皮下注射,每日1次连续7 d。截取耳缘静脉、前腔静脉以及PICC导管进行HE染色,光镜下观察并比较四组实验兔不同部位的CRT发生率以及凝血功能情况。结果A组CRT发生率为100%,D组无血栓发生,A组与其它三组间血栓发生率比较差异有统计学意义(P<0.01)。其中,A组、B组、C组实验兔耳缘静脉血栓发生率与D组比较差异有统计学意义(P<0.01)。A组、B组的PICC导管血栓发生率与C组、D组间比较差异有统计学意义(P<0.01)。PICC置管一周后,血PT、APTT、TT、FIB、D-D二聚体含量在各组间比较差异有统计学意义(P<0.01)。结论不同浓度低分子肝素对CRT形成有预防作用,且随着浓度的递升作用渐增,其中高浓度低分子肝素200μ/(mL·d)可有效预防CRT形成并降低发生率,具有重要的临床意义。Objective To explore the inhibitory effect of various concentrations of low molecular weight heparin on the formation of catheter-related thrombosis(CRT).Methods Forty rabbits were divided into group A(control group),group B(low concentration low molecular weight heparin group),group C(medium concentration low molecular weight heparin group),and group D(high concentration low molecular weight heparin group)in accordance with a random number table.After successfully establishing the PICC catheterized rabbit model,a 0.9%sodium chloride solution,or 50μ/(mL·d),100μ/(mL·d),or 200μ/(mL·d)low molecular weight heparin sodium solutions were applied.The solution was injected subcutaneously into the abdomen of the rabbits once a day for 7 consecutive days.The auricular vein,anterior vena cava,and PICC catheters of the rabbits were removed for HE staining,and the incidence of CRT and coagulation functions in different parts were observed and compared under a light microscope.Results The incidence of CRT in group A was 100%and there was no thrombosis in group D.The difference in the incidence of thrombus between group A and the other three groups was statistically significant(P<0.01).The incidences of rabbit auricular vein thrombosis in groups A-C were significantly different from that of group D(P<0.01).The incidences of PICC catheter thrombosis in groups A and B were significantly different from that in groups C and D(P<0.01).One week after PICC insertion,blood PT,APTT,TT,FIB,and D-D dimer levels were significantly different among the groups(P<0.01).Conclusions Different concentrations of low molecular weight heparin have a preventive effect on the formation of CRT.A high concentration low molecular weight heparin 200μ/(mL·d)effectively prevents the formation of CRT and reduces its incidence,which has important clinical significance.

关 键 词：PICC 导管相关性血栓 低分子肝素 抑制 动物模型 

分 类 号：R-33[医药卫生]