低分子肝素预防幕上高血压脑出血术后下肢深静脉血栓形成的效果观察

目的 评价高血压脑出血术后使用低分子肝素预防下肢深静脉血栓形成的效果。方法 选择符合条件的82例高血压脑出血术后患者分为预防组和对照组。预防组42例,术后第3天预防性皮下注射低分子肝素钙,1次/d,连续使用14 d,同时每日行间隙气压治疗。对照组40例,仅行间隙气压治疗,未行抗凝治疗。术前2组均行血浆D-二聚体检测,术后7、14、21 d行D-二聚体检测及双下肢静脉超声检查。结果 预防组发生下肢深静脉血栓1例（2.38%）,颅内出血1例（2.38%）。对照组发生下肢深静脉血栓9例（22.50%）,肺栓塞1例（2.50%）,颅内出血1例（2.50%）。两组间的再出血及肺栓塞发生率差异无统计学意义,而下肢深静脉血栓形成差异有统计学意义（P〈0.05）。两组间血浆D-二聚体对比,术前、术后21 d差异无统计学意义,术后7 d、14 d差异有统计学意义（P〈0.05）。结论 高血压脑出血术后患者使用小剂量低分子肝素预防下肢深静脉血栓形成安全有效,应积极推广。

Low dose of low molecular weight heparin for prevention of lower extremity deep vein thrombosis after hypertensive intracerebral hemorrhage operation

Objective To evaluate the outcome of low molecular weight heparin（ LMWH） for the prevention of lower extremity deep vein thromboembolism（ LDVT） in patients with hypertensive intracerebral hemorrhage after operation. Methods 82 patients with hypertensive intracerebral hemorrhage after operation were divided into two groups： prothylactic group（ n = 42） and control group（ n = 40）. The patients in prothylactic group were injected hypodermically with LMWH from day 3 to day 14 after operation and treated with intermittent pneumatic compression from 1 to 21 days continuously. Whereas the patients in control group were treated only by intermittent pneumatic compression. The plasma D-dimer（ D-D） was measured in all patients before operation and was determined at day7,14,21 after operation. The deep veins of lower limbs in all patients were examined with colour Doppler at day 7,14,21 after operation to observe venous thromboembolism. Results Only one case of deep vein thrombosis in prothylactic group（ 2. 38%）,and one cerebral hemorrhage（ 2. 38%） recurred. In control group,deep vein thrombosis was found in 9 cases（ 22. 50%）,and one cerebral hemorrhage（ 2. 50%） recurred,and one pulmonary embolism（ 2. 50%） was found. The DVT incidence between two groups was significantly different（ P〈0. 05）,but the PTE incidence was not significantly different. D-D content at days 7,14 after operation in control group was significantly higher than that in prophylactic group（ P〈0. 05）,but the D-D level had no significant difference before operation and at day 21 after operation between the two groups. Conclusions LMWH is safe and effective for the prevention of LDVT in patients after hypertensive intracerebral hemorrhage operation.