皮下注射低分子肝素钙预防烧伤植皮后深静脉血栓形成的临床观察

目的：观察皮下注射低分子肝素钙预防烧伤植皮后卧床患者深静脉血栓形成的效果。方法：将86例双下肢烧伤或需行大腿供皮（双下肢术区面积≥5%TBSA）的烧伤患者随机分为治疗组和对照组。对照组患者行肌肉收缩、足趾活动等基础性预防深静脉血栓的措施。治疗组在对照组措施的基础上,手术后第4天开始每晚1次皮下注射低分子肝素钙5000 IU,连续10 d。术后第1、3、7、14天检测血浆D-二聚体浓度变化、治疗组血小板数量变化、两组皮片成活率及愈合时间,术前及术后14 d血管彩色多普勒检测两组患者双下肢血栓形成情况。结果：两组术后第1 d血浆D-二聚体水平均升高,第3天有所下降,第7、14天治疗组基本维持在正常范围,对照组则逐渐升高,两组间差异显著（P＜0.05）。治疗组患者血管彩色多普勒检查未见血栓形成,对照组1例患者下肢出现微血栓。两组患者皮片成活率及愈合时间无明显差异（P＞0.05）。使用 D-二聚体治疗对血小板无明显影响（P＞0.05）。结论：皮下注射低分子肝素钙联合动态监测D-二聚体对烧伤植皮患者DVT预防和监测有一定临床意义。

Clinical observation on the effect of low molecular weight heparin in preventing deep vein thrombosis in bedridden pa-tients undergoing skin-grafting

Objective：To observe the clinical effect of low molecular weight heparin （LMWH）on preventing deep vein thrombosis （DVT）in bedridden patients undergoing skin-grafting. Methods：Eighty-six patients with burn inj ury of both lower limbs or skin donor site on the thigh were randomly divided into two groups. The patients in the control group were given conventional therapy to prevent DVT,such as encouragement of constant contraction of muscles and active move-ment of toes. In the treatment group,5 000 IU LMWH was subcutaneously injected every evening from the fourth day after skin-graft in addition to above muscular contraction for 1 0 days. Automated latex immunoassay was used to assess plasma D-Dimmer 1 ,3 ,7 ,1 4 days postoperation. At the same time,the amount of platelets was monitored in the treat-ment group,and the healing time,and the survival rate of skin graft were compared between the two groups. Color Doppler echocardiography was used to detect DVT pre-operatively and 1 4 days postoperative. Results：Levels of D-Dim-mer increased on day 1 postoperation,and then it declined on day 3 in both groups. It remained normal on day 7 and 1 4 in the treatment group,but it increased in the control group,the difference between the two groups was statistically sig-nificant （P〈0.05）. No DVT was found in the lower limb of the treatment group with color Doppler echocardiography, but microthrombus in deep vein of lower limb was found in 1 patient in the control group. Healing time and the survival rate of skin grafts were similar between two groups （P〉0.05）,and no untoward effects of LMWH on platelets were ob-served. Conclusions：Subcutaneous inj ection of LMWH in patients undergoing skin grafting may have some clinical value in prevention and survellance of development of DVT after donation of skin grafts.