低分子肝素及丹参预防直肠癌术后深静脉血栓的对照研究

目的：研究低分子肝素及丹参注射液预防直肠癌术后深静脉血栓（DVT）形成的疗效及安全性。方法：将行直肠癌根治手术的患者 200 例,通过随机数字表法分为 4 组,对照组滴注 5% 葡萄糖注射液（如患有糖尿病,按比例加入普通胰岛素）,丹参注射液组（组 1）、低分子肝素组（组 2）、低分子肝素联合丹参注射液组（组 3）,每组 50 例。均行腹腔镜手术治疗,记录 4 组一般资料、手术资料、以及术前、术后 3 天、7 天凝血指标,统计术后每组出现 DVT 以及发生出血倾向例数。结果：组 1、组 2、组 3 术后各时间点的 PLT、PT、APTT、TT 指标与对照组相比,差异无统计学意义（P>0.05）;组 1 术后 3 天、术后 7 天的 FIB、D-D 指标与对照组比较差异无统计学意义（P>0.05）;组 2 术后 3 天的 FIB（6.71±1.87）g/L、D-D（1.14±0.79）mg/L、术后 7 天的 FIB（5.18±2.37）g/L、D-D（0.98±0.63）mg/L 水平低于对照组术后 3 天的 FIB（8.78±1.02）g/L、D-D（1.69±0.35）mg/L、术后 7 天的 FIB（5.18±2.37）g/L、D-D（0.98±0.63）mg/L 和组1 术后 3 天的 FIB（7.83±0.95）g/L、D-D（1.58±0.51）mg/L、术后 7 天的 FIB（6.89±1.58）g/L、D-D（1.21±0.28）mg/L 水平,差异有统计学意义（P<0.05）;组 3 术后 3 天的 FIB（4.89±2.51）g/L、D-D（0.67±0.34）mg/L、术后 7 天的 FIB（3.38±0.95）g/L、D-D（0.47±0.25）mg/L 水平低于对照组、组 1、组 2 术后 3 天及术后 7 天的 FIB 和 D-D 水平,差异有统计学意义（P<0.05）。术后组 3 有 1 例发生 DVT,低于对照组（8 例）、组 1（7 例）、组 2（4 例）DVT 发生例数,差异有统计学意义（P<0.05）。结论：低分子肝素联合丹参注射液可以显著预防直肠癌术后 DVT 的发生,同时安全性较好。     

疏血通联合低分子肝素钠治疗深静脉血栓的疗效观察

目的探讨疏血通联合低分子肝素钠治疗下肢深静脉血栓症的临床疗效和安全性。方法将70例下肢深静脉血栓症患者随机分为试验组和对照组,每组各35例。对照组予低分子肝素纳5000U皮下注射,每12小时1次。试验组在此基础上加用疏血通注射液6mL＋生理盐水250mL静脉点滴,每天1次,10d为一疗程。结果试验组总有效率94.3%,对照组为68.6%,两组比较差异有统计学意义（P〈0.05）,两组均未出现严重不良反应。结论疏血通联合低分子肝素钠治疗下肢静脉血栓症疗效显著,安全性好。     

Dose Titration Study of Tinzaparin, a Low Molecular Weight Heparin, in Patients on Chronic Hemodialysis

The minimal necessary dose of Innohep (IH) (MNDI) (Innohep [tinzaparin], Leo Pharmaceutical Corp., Ballerup, Denmark) was examined in 40 patients switched from conventional heparin ([CH], Leo Pharmaceutical Corp.) to IH and in 13 patients already treated with IH. Clotting in the venous chamber and in the dialyzer was evaluated on a 4 point scale by visual inspection. IH was administrated as a bolus injection into the arterial side of the dialyzer at the beginning of dialysis sessions. The initial dose of IH was 50% of the total dose of CH used before the study (in respective IU). According to clotting in the venous chamber or dialyzer, the dose of IH was titrated by stepwise changes of 500 IU to the lowest possible dose until 3 subsequent dialysis sessions without clotting were obtained. The total dose of CH (bolus and infusion) before switching was 6,162 ± 2,100 IU. The bleeding time from the cannulation site after dialysis, in 24 patients with A-V fistulas, was 7.1 ± 2.8 min(triplicates). Eight patients were excluded before achieving the MNDI, 3 due to bleeding not clearly related to heparinization (1 due to gingival bleeding, 1 to epistaxis, and 1 to sugillations), 1 due to alopecia, 2 due to a need of more than 10,000 IU of IH, and 2 patients due to cessation of treatment resulting from anxiety. After switching over, the MNDI amounted to 66 ± 26% in respective IU. The conversion IH/CH ratio correlated significantly to the blood flow rate and the type of dialyzer. When compared on 3 subsequent sessions before and after switching to IH, no differences were found in the bleeding time after decannulation and in clotting in the venous chamber while dialyzer clotting fell on the visual scale from an average of 0.36 to 0.19 (p < 0.01). No total clot formation was observed during the study. The MNDI correlated positively to the body weight, blood flow rate, and time on dialysis (with the respective coefficients of correlation of r being 0.58, 0.44, and 0.30, p < 0.05) and was also influenced by the type of dialyzer. The average MNDIs for the Hemoflow-FS hollow-fiber (Fresenius, Bad Homburg, Germany), Lundia PRO plate (Gambro, Lund, Sweden), and Polyflux hollow fiber (Gambro) were 2,571, 3,727, and 5,020 IU (p < 0.01, ANOVA). In patients on chronic hemodialysis, IH given as a bolus of 4,250 IU effectively prevented extracorporeal clotting during dialysis, similarly to CH. However, a considerable individual variation in MNDIs not related to the need for CH was observed, and this necessitates individual dosage adjustments to obtain the optimal prevention of clotting with minimal bleeding risk.     

间歇充气装置和低分子肝素预防消化系肿瘤术后下肢深静脉血栓形成的效果

目的探讨间歇充气装置(intermittent pneumatic compression,IPC)和低分子肝素(low molecular weight heparin,LMWH)预防消化系肿瘤术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的效果。方法 2008年1～8月60例因消化系肿瘤行根治性手术,按随机数字表法分为3组,因未完成术后检查或治疗等依从性不好的因素,造成无法判断效果而剔除7例,最终入组53例:20例无预防措施(对照组)、15例术中和术后使用IPC(IPC组)及18例术后使用低分子肝素治疗(LMWH组)。术前和术后3～10 d行双下肢血管超声检查,记录DVT发生情况。对所有患者术前、术后第1、3、7天的血小板(PLT)、凝血酶原时间(PT)和国际标准化比值(INR)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)进行分析。结果对照组、IPC组、LMWH组DVT发生率分别为30.0%(6/20)、20.0%(3/15)和5.6%(1/18),组间比较差异无显著性(χ2=4.165,P=0.125),LMWH组与对照组比较差异无显著性(Fisher’s检验,P=0.061)。10例发生血栓患者中超重、血栓栓塞病史的发生率显著高于43例未发生血栓患者(χ2=5.106,P=0.024;χ2=5.106,P=0.024)。发生血栓患者术前、术后第1天和第3天血小板明显高于未发生血栓患者(t=2.676,P=0.000;t=2.203,P=0.032;t=3.040,P=0.004),术后第3天D-D也明显高于未发生血栓者(Z=-2.355,P=0.018),其余观察指标均无统计学差异(P>0.05)。术后第3天LMWH组PT较对照组明显延长(P=0.017),INR也较对照组明显升高(P=0.035),3组间手术前后血小板、APTT、FIB、D-D差异无显著性(P>0.05)。结论单一使用IPC和LMWH未能减少消化系肿瘤术后下肢DVT的发生,但使用低分子肝素有减少消化系肿瘤患者术后DVT发生的趋势,超重和血栓栓塞病史可能是发生血栓的危险因素。     

不同剂量低分子肝素预防腰椎内固定术后静脉血栓栓塞症的安全性分析

目的 比较不同剂量低分子肝素预防腰椎内固定术后静脉血栓栓塞症(venous thromboem-bolism,VTE)的安全性.方法 选取我院2020年7月1日至2020年12月31日行腰椎后路内固定手术的206例病人,随机分为A组和B组.其中A组103例,男56例,女47例,年龄为(45±15)岁,术后每天应用500...     

Anticoagulation with Low Molecular Weight Heparin (Fragmin) during Continuous Hemodialysis in the Intensive Care Unit

Abstract: A preparation of low molecular weight heparin (Fragmin) was administered to patients with multiorgan failure receiving continuous venovenous hemodialysis. Three patients received a high-dose regimen (35 IU/kg bolus followed by 13 IU/kg infusion), and 7 received a low-dose regimen (8 and 5 IU/kg, respectively) for 36 h. High-dose Fragmin was associated with minimal clotting in the extracorporeal circuit. Plasma fibrinopeptide A levels declined, and mean anti-Xa activity was in the range 0.47-0.79 IU/ml. The urea equilibration coefficient (UEC) (100% at initiation) remained above 90% throughout. All 3 patients had mild bleeding episodes, which led to discontinuation of Fragmin in 1. During all low-dose treatments, marked thrombus formation occurred in the extracorporeal circuit, and in 2, the circuit clotted within the study period. Fibrinopeptide A levels further increased in 4 patients, and mean anti-Xa activity was in the range 0.27-0.53 IU/ml. UEC declined appreciably in 3 treatments (including the 2 in which early circuit clotting occurred). One patient experienced a mild bleeding episode. The low-dose Fragmin regimen produced safer anticoagulation in patients at risk from bleeding and is suitable for prolonged renal support although the tendency to thrombosis may necessitate more frequent circuit changes.     

Usefulness of Thrombelastography for Dosage Monitoring of Low Molecular Weight Heparin and Unfractionated Heparin During Hemodialysis

Low molecular weight heparin (LMH) acts as an anticoagulation agent mainly through its anti-activated coagulation factor X (Xa) activity. Thrombelastography (TEG) is expected to be useful to monitor the dosage of LMH during hemodialysis because reaction time on TEG (TEG-r) is considered to reflect blood thromboplastin formation time, which depends on the formation of Xa. To test this possibility, we compared the usefulness of TEG, activated coagulation time (ACT), activated partial thromboplastin time (APTT), and anti-Xa activity in 28 hemodialysis patients using both conventional unfractionated heparin (UFH) and LMH on separate dialysis procedures. Anti-Xa activity of LMH was comparable to that of UFH when it was measured using both LMH and UFH as standards. Anti-Xa activity, which theoretically depended on the heparin concentration in blood samples, did not correlate with the degree of dialyzer clotting. The APTT correlated well with anti-Xa activity in patients using LMH (r = 0.686, p less than 0.01) and UFH (r = 0.906, p less than 0.01), but not with the degree of dialyzer clotting. The TEG-r correlated well with the degree of dialyzer clotting both in patients using LMH and those using UFH (measurements of samples obtained from the venous side of the extracorporeal circuit) and weakly correlated with anti-Xa activity in patients using LMH (r = 0.402, p less than 0.05). The ACT did not correlate with the degree of dialyzer clotting or anti-Xa activity. These results suggest that TEG-r reflects the efficacy of heparin in the extra-corporeal blood circuit, whereas APTT mainly reflects heparin concentration of the blood samples.(ABSTRACT TRUNCATED AT 250 WORDS)     

苦碟子预防老年骨盆髋臼骨折术后下肢深静脉血栓形成的临床研究

目的:探讨苦碟子注射液联合低分子肝素预防老年骨盆及髋臼骨折术后下肢深静脉血栓(LEDVT) 形成的效果及机制。方法:选取2018 年1 月—2019 年1 月老年骨盆髋臼骨折患者共100 例,采用随机数字法分为对照组(n =50)及观察组(n =50)。在常规治疗基础上,对照组术后给予低分子肝素治疗,观察组术后给予低分子肝素联合苦碟子注射液治疗。治疗后,比较两组患者LEDVT 发生率、患肢肿胀程度、疼痛程度、血液流变学指标、炎性因子水平、凝血功能及不良反应发生情况。结果:术后30 天内,LEDVT 发生率观察组为6%,低于对照组的20%,差异有统计学意义(P <0.05)。术后7 天,与对照组比,观察组血液流变学指标及炎性因子显著下降,差异有统计学意义(P <0.05)。患肢肿胀、疼痛程度观察组较对照组明显减轻,差异有统计学意义(P <0.05)。观察组与对照组凝血功能差异无统计学意义(P >0.05)。观察组与对照组不良反应发生率分别为6% 和4%,差异无统计学意义(P >0.05)。结论:苦碟子注射液联合低分子肝素能够有效预防老年骨盆髋臼骨折术后LEDVT 的发生,显著改善患者血液流变学指标,减轻机体炎症反应,减轻患者患肢肿胀、疼痛程度,且不良反应轻微,临床上值得推广应用。     

A Survey of Deep Venous Thrombosis Management by Consultant Vascular Surgeons in the United Kingdom and Ireland

OBJECTIVES: The aim of this study was to detail the current consensus amongst vascular surgeons in Great Britain and Ireland regarding their investigation and management of patients with suspected or proven deep vein thrombosis (DVT). METHODS: The database of the Vascular Surgical Society of Great Britain and Ireland (VSS) was utilised to send coded postal questionnaires to all consultant surgeon members. RESULTS: Replies were received from 281 (65%) consultants. Duplex ultrasound is used alone to confirm DVT by 69% of respondents. A thrombophilia screen is always performed by 14% of consultants, for patients with proven DVT, and is more commonly requested by consultants based in a teaching hospital. The majority (57%) of consultants treat DVT with unfractionated heparin (UFH) and warfarin, whereas only 38% utilise low molecular weight heparins (LMWH) and warfarin. A management policy for DVT is reported to be in place by 59%, and a set policy for the specific management of calf vein DVT by just 20%. CONCLUSION: New diagnostic modalities and treatments have been developed for DVT that are more convenient and cost-effective. Although clinical guidelines for the management of patients with DVT are beginning to emerge, there is still a wide discrepancy in many areas of DVT management, and practice at variance with the current evidence base, amongst vascular surgeons in the United Kingdom and Ireland.     

红花黄色素联合低分子肝素预防骨科术后深静脉血栓Meta分析

目的:评价红花黄色素联合低分子肝素预防骨科术后深静脉血栓形成(DVT)的疗效及安全性。方法:全面检索PubMed、EMbase、Cochrane Library、CNKI、维普和万方数据库中收录的红花黄色素联合低分子肝素预防骨科术后DVT的随机对照研究(RCT),检索时限从2000年1月—2018年6月。提取资料进行质量评价,采用Rev Man5.3软件进行Meta分析。结果:共纳入8个RCT,包括624例患者。与对照组相比,联合组显著降低了DVT发生率[RR=0.28,95%CI(0.16,0.51),P0.0001];联合组活化部分凝血活酶时间(APTT)[MD=5.34,95%CI(2.31,8.36), P=0.0005]、凝血酶原时间(PT)[MD=3.09,95%CI(1.75,4.44), P0.00001]显著优于对照组。两组不良反应发生率无明显差异。结论:红花黄色素联合低分子肝素预防骨科术后DVT疗效优于单用低分子肝素。     

桃红四物汤联合低分子肝素预防骨科术后深静脉血栓 Meta分析

目的:系统评价桃红四物汤联合低分子肝素预防骨科术后深静脉血栓形成(DVT)的疗效及安全性。方法:全面检索 Cochrane Library、EMbase、PubMed、JAMA、CNKI、维普和万方数据库中收录的桃红四物汤联合低分子肝素预防骨科术后 DVT的随机对照研究(RCT),检索时限从建库— 2020年 6月。有两位研究者独立筛选文献、资料提取和质量评价后,采用 RevMan5.4软件进行 Meta分析。结果:共纳入 14项 RCTs,入选 1150例患者。 Meta分析结果显示,与低分子肝素组相比,联合组显著降低了 DVT发生率 [RR=0.32,95% CI(0.20,0.51),P<0.00001];联合组的视觉模拟评分法(VAS)疼痛评分 [MD=-1.20,95%CI(-1.39,-1.02),P<0.00001]、术后伤口引流量 [MD=-35.86,95%CI(-41.81, -29.90),P<0.00001]、血小板计数(PLT)[MD=-9.49,95%CI(-13.33,-5.66),P<0.00001]、红细胞计数(RBC)[MD=0.29, 95%CI(0.23,0.36),P<0.00001]、活化部分凝血活酶时间(APTT)[MD=1.94,95%CI(1.33,2.55),P<0.00001]、血红蛋白(HGB)[MD=4.70,95%CI(3.25,6.15),P<0.00001]、D-二聚体 [MD=-0.06,95%CI(-0.07,-0.06), P<0.00001]以及 C反应蛋白(CRP)[MD=-1.63,95%CI(-1.94,-1.32),P<0.00001]显著优于对照组;凝血酶原时间(PT)在两组比较中无统计学意义(P>0.05)。结论:桃红四物汤联合低分子肝素预防骨科术后 DVT疗效优于单用低分子肝素,且减少术后下肢深静脉血栓的形成。     

Effect of a Low Molecular Weight Heparin Molecule,Dalteparin, on Cellular Apoptosis and Inflammatory Process in an Incisional Wound-Healing Model

Purpose In this study we aimed to test the effect of a low molecular weight heparin molecule, namely dalteparin, on the inflammation and cellular apoptosis in an incisional wound-healing model in rats. Methods Eighteen male Sprague–Dawley rats were randomly assigned to three groups (n = 6 for each group). Two full-thickness skin incisions were made over cervical and lumbar regions of all rats. Group 1 (sham group) received no treatment, group 2 (control group) received 0.01 ml/g saline subcutaneously 12 h two times daily from 0 to 10th postoperative day, and group 3 (dalteparin group): received 1 IU/g dalteparin subcutaneously two times daily from 0 to 10th postoperative day. A histological evaluation was done by light microscopy. Apoptosis was detected immunohistochemically by anti-poly (ADP-ribose) polymerase p85 fragment pAb. Results The early inflammatory response and related tissue edema were depressed on day 3 in the dalteparin group when compared with those in the other groups (P < 0.05). Fibroblast proliferation was also depressed on day 10 in the dalteparin group compared to the others (P < 0.05). Furthermore, increased apoptosis was detected in the dalteparin group both on day 3 and day 10. Conclusion Our results showed that dalteparin may adversely affect the incisional wound healing by suppressing the early inflammatory process and increasing cellular apoptosis; however, further studies are warranted to confirm the results.     

低分子肝素钠股动脉注射治疗糖尿病下肢血管病变疗效观察

目的观察低分子肝素钠股动脉注射治疗糖尿病下肢血管病变的疗效。方法对40例糖尿病下肢血管病变患者在治疗糖尿病的基础上给予低分子肝素钠股动脉注射。观察治疗后临床症状、血液流变学以及血流动力学改善情况。结果治疗后患者临床症状、血液流变学以及血流动力学改善明显,治疗前后比较,差异有显著性意义(P<0.05,P<0.01);未发现不良反应。结论低分子肝素钠股动脉注射对糖尿病下肢血管病变疗效显著,安全。     

Acute Effect of Standard Heparin Versus Low Molecular Weight Heparin on Oxidative Stress and Inflammation in Hemodialysis Patients

Objective. Atherosclerotic cardiovascular diseases caused by traditional and non-traditional risk factors are the most common cause of morbidity and mortality in hemodialysis patients. Recently, much interest has been focused on non-traditional factors, such as oxidative stress, inflammation, and endothelial dysfunction. Hemodialysis patients are not only exposed to oxidative stress but also to inflammation. Although anticoagulants are the most frequently used drugs in hemodialysis patients, their effect upon oxidative stress and inflammation in dialysis patients are still unknown. Methods. Thirty-three hemodialysis patients were randomized into three groups. Group 1 received standard heparin while group 2 received low molecular weight heparin during the dialysis therapy. Group 3 (control group) did not receive any anticoagulant agent. Investigators were blinded to the therapy. Serum concentrations of oxidative stress and inflammation markers, including C-reactive protein, tumor necrosis factor alpha, superoxide dismutase, and malondialdehyde, were measured before and after dialysis session. Results. The oxidative stress and inflammation markers were significantly increased in groups 1 and 3 (p < 0.05 for each) compared to their baseline values. In contrast, baseline and end-treatment values of the oxidative stress and inflammation markers were comparable in the group 2 (p > 0.05). Conclusion. These findings indicate that the type of anticoagulants may take a role in the acute effect of hemodialysis upon oxidative stress and inflammation markers. A comparison of the groups revealed that low molecular weight heparin decreased the oxidative stress and inflammation, whereas standard heparin increased the oxidative stress and inflammation. Low molecular weight heparin appears to have an additive benefit for hemodialysis patients.     

Heparin-Induced Hyperkalemia in Chronic Hemodialysis Patients: Comparison of Low Molecular Weight and Unfractionated Heparin

Abstract: Aldosterone suppression and subsequent hyperkalemia are well described reversible side effects of prolonged treatment with heparin. This study was designed to examine whether the discontinuous use of heparin three times a week to prevent thrombosis formation during hemodialysis sessions could also induce hypoaldosteronism and might contribute to increased predialysis kalemia in hemodialysis patients. Two different heparinization regimens were prospectively compared in a crossover study of 11 chronic hemodialysis patients. During 2 consecutive weeks, the patients were dialyzed each week with either their usual doses of unfractionated heparin (UH) (6,160 IU ± 1,350 IU) or low molecular weight heparin (LMWH) (15 anti-Xa activity [aXa] U/kg + 5 aXa U/kg/h). In all but 2 patients, the predialysis level of plasma K⁺ was higher with UH than with LMWH, and the mean value was higher (5.66 ± 0.83 versus 5.15 ± 0.68 mM, p = 0.01) while no differences in the predialysis plasma concentrations of creatinine, phosphate, urea, and bicarbonate were observed, excluding the potential role of differences in diet and dialysis efficacy in explaining the higher plasma K⁺ concentration with UH. The mean plasma aldosterone to plasma renin activity (pRA) ratio was higher with LMWH than with UH (149.54 ± 123.1 versus 111.91 ± 86.22 pg/ng/h, p < 0.05). Individual plasma aldosterone values were found to be correlated to pRAs both during the UH period and the LMWH period, and the slope of the positive linear relation between plasma aldosterone and pRA was lower during the UH treatment period (63 versus 105 pg/ng/h). Finally, a negative linear correlation was found between the differences in individual predialysis plasma K⁺ observed during the 2 protocols and the differences in the corresponding plasma aldosterone levels, suggesting a link between the higher kalemia and the lower aldosterone responsiveness to angiotensin with unfractionated heparin. Although it cannot be concluded whether or not LMWH inhibits aldosterone synthesis, should LMWH decrease aldosterone production, this side effect is 33% less marked than that of UH so that the predialysis plasma K⁺ levels are 10% lower. This property makes LMWH use preferable to that of UH in patients with elevated predialysis kalemia.     

Deep Venous Thrombosis in Spine Surgery Patients: Incidence and Hematoma Formation

Deep venous thrombosis (DVT) is a significant health care problem; a variety of factors place spinal surgery patients at high risk for DVT. Our aim is to define the incidence of DVT occurrence in spite of prophylactic measures (mechanical and chemoprophylaxis), and the development of spinal epidural hematoma as a complication of chemoprophylaxis. In a single-center prospective study, 158 patients who underwent spinal surgical procedures were evaluated by clinical evaluation and lower limb Doppler ultrasonography imaging. Only one patient (0.6%) developed DVT; this patient was treated successfully without thrombus progression, with full recanalization. Three patients (1.8%) developed spinal epidural hematoma, but only one required surgical evacuation, and none sustained neurologic deficit. Careful evaluation for DVT risk on an individual basis and good prophylaxis helps to minimize the risk of DVT. The neurosurgeon is thus left to weigh the risks of postoperative hematoma formation against the benefits of protecting against DVT.     

Comparison of Clinical and Physiological Efficacies of Different Intermittent Sequential Pneumatic Compression Devices in Preventing Deep Vein Thrombosis: A Prospective Randomized Study

Background

There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis (DVT). The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups (an alternate sequential compression device [ASCD] vs. a simultaneous sequential compression device [SSCD]).

Methods

In total, 34 patients (68 limbs) undergoing knee and spine operations were prospectively randomized into two device groups (ASCD vs. SSCD groups). Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics. Continuous data for the two groups were analyzed using a two-tailed, unpaired t-test. Relative frequencies of unpaired samples were compared using Fisher exact test. Mixed effects models that might be viewed as ANCOVA models were also considered.

Results

DVT developed in 7 patients (20.6%), all of whom were asymptomatic for isolated calf DVTs. Two of these patients were from the ASCD group (11.8%) and the other five were from the SSCD group (29.4%), but there was no significant difference (p = 0.331). Baseline peak velocity, mean velocity, peak volume flow, and total volume flow were enhanced significantly in both device groups (p < 0.001). However, the degrees of flow and velocity enhancement did not differ significantly between the groups. The accumulated expelled volumes for an hour were in favor of the ASCD group.

Conclusions

Both graded sequential compression devices showed similar results both in clinical and physiological efficacies. Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis.     

低分子肝素皮下注射局部压迫与否对出血的影响

目的 探讨低分子肝素(LMWH)皮下注射后局部压迫与否与局部出血的关系。方法 选择60例冠心病行皮下注射LMWH的病人,采用自身对照法,即一次注射后局部不压迫,另一次注射后局部压迫3～5 min。观察皮下出血发生率及出血程度。结果 局部不压迫皮下出血率及重度出血率显著低于压迫者(均P<0.01)。结论 皮下注射LMWH局部不压迫可以有效降低皮下出血发生率及其严重程度。     

Effects of Low Molecular Weight Heparin on the Frequencies of Intradialytic Arrhythmias in Hemodialysis Patients

Arrhythmia is known to cause sudden death in hemodialysis patients. Heparin administration releases lipoprotein lipase from the capillary endothelial cell surface, resulting in an increase in the plasma levels of free fatty acids; higher levels of free fatty acids may affect the occurrence of arrhythmias. This study assessed whether the occurrence of arrhythmias during hemodialysis could be suppressed by replacing unfractionated heparin with low molecular weight heparin. Ten dialysis patients who had supraventricular premature contraction and/or ventricular premature contraction were monitored by the Holter electrocardiograph system during hemodialysis. To investigate the effect of each form of heparin on plasma lipid metabolism, the lipoprotein lipase and lipid levels before and during hemodialysis were measured. The occurrence of arrhythmias was significantly suppressed in hemodialysis using low molecular weight heparin, as compared with hemodialysis using unfractionated heparin. Lower lipoprotein lipase and free fatty acids levels were also observed in hemodialysis using low molecular weight heparin. The authors concluded that hemodialysis using low molecular weight heparin instead of unfractionated heparin could be effective in protecting hemodialysis patients with arrhythmias against arrhythmia-related cardiac events.