低分子肝素预防腹部手术后深静脉血栓形成的效果

目的：探讨普外腹部术后早期应用低分子肝素预防深静脉血栓形成（DVT）的有效性和安全性。方法：将2011年7月至2012年6月收治的60例腹部手术患者随机分为治疗组（30例）和对照组（30例）。治疗组术后4h注射低分子肝素（43抗xa活性单位／Kg），以后每24小时注射低分子肝素（85抗xa活性单位／kg）至术后1周：对照组按相同方法应用注射用水。术后2、7d行下肢静脉彩色多普勒超声检查；记录术后出血量、手术前后血小板计数（PIJT）、凝血酶原时间（T）、部分活化凝血酶原时间（APTT）、D-二聚体（DD）、纤维蛋白原（Fbg）和C-反应蛋白（CRP）等指标。结果：治疗组1例发生下肢DVT（周围型），对照组8例发生下肢DVT（1例混合型、7例周围型），两组比较，差异有统计学意义（P〈0．05）。两组均未发生致死性肺栓塞；两组术后出血量、胛、APT、TT和PLT比较，差异无统计学意义（P〉0．05）：两组CRP、Fbg和DD在术后48h均明显升高，与术前比较，差异有统计学意义（P〈0．05）；对照组的CRP和Fbg在术后48h和术后7d均高于治疗组（P〈0．05）。结论：腹部术后早期应用低分子肝素可减少术后深静脉血栓的发生，且不增加术后出血.

Effects of low-molecular heparin on prevention of postoperative deep vein thrombosis following general abdominal surgery

Objective： To examine the efficacy and safety of early application of low-molecular heparin for prevention of deep vein thrombosis （DVT） following general abdominal surgery. Methods： Sixty patients who underwent abdominal surgery between July 2011 and June 2012 were randomly assigned to be treated with low- molecular heparin injection （43 anti-XX unit/kg） at 4h followed by injection （85 anti-XX unit/kg） once daily for 1 week （ treatment group, n = 30 ） or injection of natural saline for an identical course （ control group, n = 30）. This was followed by color Doppler ultrasonography of the lower extremity at days 2 and 7 postoperatively. The postoperative blood loss, preoperative platelet count （PLT）, prothrombin time （PT）, activated partial thromboplastin time （AIrI＇T）, D-dimmer （DD）, fibrinogen （Fbg） and C-reactive protein （CRP） were recorded. Results： A single case in treatment group （peripheral DVT） and 8 cases in control group （mixed DVT in 1 case and peripheral DVT in 7 cases ） developed DVT of the lower extremities （ P 〈 0.05 ）. No life- threatening pulmonary thromboembolism was reported. The differences in postoperative blood loss, PT, AlYFF, TT and PLT did not reach statistical significance between the two groups （ all P 〉 0. 05 ）. Compared with preoperative levels, both groups yielded markedly increased levels of postoperative CRP, Fbg and DD at 48h postoperatively （ all P 〈 0.05 ）. Control group was associated with considerably higher levels of CRP and Fbg at 48h and day 7 postoperatively compared with treatment group （all P 〈 0.05 ）. Conclusion： Early application of low-molecular heparin following abdominal surgery may reduce the risk of DVT yet does not increase the risk of postoperative hemorrhage.