胰腺癌术后应用低分子肝素钙预防深静脉血栓的临床价值

目的:探讨低分子肝素钙预防胰腺癌术后深静脉血栓的临床价值.方法:选取胰腺癌患者180例,根据术后是否应用低分子肝素钙随机分为治疗组和对照组.分别在治疗前后比较两组患者组织型血浆酶原激活剂(t-PA)、血浆酶原激活抑制剂(PAI)、纤维蛋白原(FIB)及D-二聚体(D-D)的差异,观察有无发生深静脉血栓(DVT)及术后出血等不良反应,并对DVT患者进行危险因素分析.结果:对照组、治疗组术后PAI、FIB以及D-D水平均较术前低,t-PA水平较术前高;治疗组术后PAI、FIB以及D-D水平均较对照组术后低,t-PA水平较对照组高,差异均有统计学意义(分别P<0.05及P<0.01).治疗组DVT、肺栓塞、心肌梗死发生率低于对照组,差异有统计学意义(P<0.05);心源性猝死和术后出血发生率两组差异无统计学意义(P>0.05).多因素分析结果显示,肥胖、既往冠心病、下肢静脉曲张是导致胰腺癌术后易患DVT的独立危险因素(P<0.05).结论:早期应用低分子肝素钙对于预防胰腺癌术后伴发DVT安全且疗效肯定.

Application of low molecular heparin calcium in the prevention of deep vein thrombosis after pancreatic cancer operation

Objective:To evaluate the clinical value of the low molecular heparin calcium to prevent pancreatic cancer postoperative deep vein thrombosis.Methods:All 180 cases of pancreatic cancer patients,according to whether the postoperative application of low molecular heparin calcium were randomly divided into treatment group and control group.Compared two groups patients before and after therapy organization type plasma enzyme original activator (t-PA) and plasma enzyme activation inhibitor (PAI),fibrinogen (FIB) and D-dimer (D-D),observed deep vein thrombosis (DVT),hemorrhage and other adverse reactions,analysised the risk factors in patients with DVT.Results:Postoperative PAI,FIB and D-D levels in control group and treatment group were relatively lower than preoperative,t-PA level compared with preoperative high;postoperative PAI,FIB and D-D levels in treatment group were lower than the control group,t-PA level higher than control group,the above differences were statistically significant (P<0.05 and P<0.01).Treatment group DVT,pulmonary embolism,myocardial infarction incidence was lower than the control group,the difference was statistically significant (P<0.05);Sudden cardiac death and the incidence of postoperative bleeding had no statistically significant differences between the two groups (P>0.05).Multiple factors analysis showed obesity,coronary heart disease,lower extremity varicose veins is susceptible to DVT after pancreatic cancer surgery were independent risk factors (P<0.05).Conclusion:Early application of low molecular heparin calcium to prevent after pancreatic cancer surgery with DVT is safe and effective.