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。

Low-molecular-weight Heparin and Salvia Miltiorrhiza Injection in Prevention of Deep Venous Thrombosis after Rectal Cancer Surgery: a Prospective Randomized Controlled Trial

Objective To study the efficacy and safety of low-molecular-weight heparin and Salvia miltiorrhiza injection in preventing deep venous thrombosis after rectal cancer operation. Methods Totally 200 patients who underwent radical resection of rectal cancer were divided into 4 groups randomly, such as control group with 5% Glucose Injection (diabetes mellitus with regular insulin proportionally), Salvia miltiorrhiza injection group (group 1), low-molecular-weight heparin group (group 2), and low-molecular-weight heparin combined with Salvia miltiorrhiza injection group (group 3), with 50 cases in each group, and all patients were treated with laparoscopic operation by the same physician. The statistics of general information, surgical data, and blood coagulation parameters were measured preoperative and postoperative 3 d and 7 d after operation were recorded in 4 groups. The number of patients with DVT and bleeding tendency after operation were counted. Results The PLT, PT, APTT, TT indexes of groups 1, 2 and 3 were not signifificant compared with those of control group (P>0. 05). There was no significant difference in FIB and D-D between group 1 and control group 3 and 7 d after operation (P>0.05). FIB (6.71±1.87) g/L and D-D (1.14±0.79) mg/L in 3 d after operation, FIB (5.18±2.37) g/L and D-D (0.98±0.63) mg/L in 7 d after operation in group 2 were lower than those in the control group after 3 d [FIB (8.78±1.02) g/L and D-D (1.69±0.35) mg/L], after 7 d [FIB (5.18±2.37) g/L and D-D group (0.98±0.63) mg/L] and group 1 after 3 d [FIB (7.83±0.95) g/L and D-D (1.58±0.51) mg/L], after 7d [FIB (6.89±1.58) g/L and D-D (1.21±0.28) mg/L], with statistically significant difference (P<0.05). In group 3, the indexes postoperative 3 d [FIB (4.89±2.51) g/L and D-D (0.67±0.34)mg/L], 7 d after operation [FIB (3.38±0.95) g/L and D-D (0.47±0.25) mg/L] were lower than those in the control group, group 1 and group 2 postoperative 3d and 7 d after operation, with statistically signifificant difference (P<0.05). There was only 1 case of DVT in group 3 after operation, there was signifificant difference compared with control group (8 cases), group 1 (7 cases) and group 2 (4 cases) (P<0.05). There was no signifificant difference among the four groups in terms of bleeding in other parts after operation (P>0.05). Conclusion Low-molecular-weight heparin combined with Salvia miltiorrhiza injection can signifificantly prevent the occurrence of DVT after rectal cancer surgery.