術后早期應用低分子肝素對胃腸道惡性腫瘤術后深靜脈血栓形成的影響_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 胡殿賀 ¹ , 韓亞東 ² ,  侍陽 ² , 朱孝成 ²

1. ;
2. ;

Corresponding?author：

侍陽, Email: shiyang999@126.com

Keywords：

胃腸道惡性腫瘤; 低分子肝素; 深靜脈血栓; 預防

DOI：

10.7507/1007-9424.20160129

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的探討術后早期應用低分子肝素（LMWH）對預防胃腸道惡性腫瘤患者術后下肢深靜脈血栓（DVT）形成的安全性和有效性。方法將2014年7月至2015年7月期間徐州醫學院附屬醫院普外科收治的92例胃腸道惡性腫瘤患者隨機分為2組，即住院號末尾數為奇數者納入低分子肝素組，偶數者納入對照組，最終低分子肝素組47例、對照組45例。低分子肝素組于術后12～24 h開始于腹部皮下注射依諾肝素4 000 U，1次/d，用至術后第7天；對照組未采取預防性用藥。術后第7天清晨抽取靜脈血檢測凝血功能、D-二聚體（DD）及血小板（PLT）指標；記錄患者術后7 d內腹腔引流量，評價安全性；術后1周復查雙下肢深靜脈彩超，比較2組DVT發生率。結果 2組患者一般資料比較其差異無統計學意義，具有可比性（P＞0.05）。術后第7天2組患者的凝血酶源時間（PT）、活化部分凝血酶時間（APTT）及PLT相比差異無統計學意義（P＞0.05）；低分子肝素組術后第7天纖維蛋白原（FIB）及DD明顯低于對照組，差異有統計學意義（P＜0.05）。2組患者術后7 d內腹腔引流量差異無統計學意義（P＞0.05）；2組患者術后下肢DVT發生率差異有統計學意義，對照組高于低分子肝素組（P＜0.05）。結論術后早期應用低分子肝素可有效降低胃腸道惡性腫瘤患者術后下肢DVT形成，且不增加出血風險。

Citation： 胡殿賀, 韓亞東, 侍陽, 朱孝成. 術后早期應用低分子肝素對胃腸道惡性腫瘤術后深靜脈血栓形成的影響. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 487-489. doi: 10.7507/1007-9424.20160129 Copy

1.	Büller HR, Prins MH, Lensing AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366(14):1287-1297.
2.	Cheung HY, Chung CC, Yau KK, et al. Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in Chinese patients.Asian J Surg, 2008, 31(2):63-68.
3.	Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation, 2003, 107(23 Suppl 1):I9-I16.
4.	Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer:American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013, 31(17):2189-2204.
5.	Smith BR, Diniz S, Stamos M, et al. Deep venous thrombosis after general surgical operations at a university hospital:two-year data from the ACS NSQIP. Arch Surg, 2011, 146(12):1424-1427.
6.	Laryea J, Champagne B. Venous thromboembolism prophylaxis. Clin Colon Rectal Surg, 2013, 26(3):153-159.
7.	袁訓芝, 吳新民, 袁家穎, 等.壓力梯度長襪和間歇充氣裝置預防惡性腫瘤患者術后下肢深靜脈血栓形成的效果.中華麻醉學雜志, 2006, 26(2):103-106.
8.	Vaitkus PT, Leizorovicz A, Cohen AT, et al. Mortality rates andrisk factors for asymptomatic deep vein thrombosis in medical patients. Thromb Haemost, 2005, 93(1):76-79.
9.	Saxena A, Mittal A, Arya SK, et al. Safety and efficacy of low-molecular-weight heparins in prophylaxis of deep vein thrombosis in postoperative/ICU patients:A comparative study. J Nat Sci Biol Med, 2013, 4(1):197-200.
10.	Mismetti P, Laporte S, Darmon JY, et al. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolismin general surgery. Br J Surg, 2001, 88 (7):913-930.
11.	陶國全, 葛恒發, 姜寶飛, 等.腹腔鏡結直腸術后并發癥的處理.中華消化外科雜志, 2011, 10(1):47-47.
12.	葉華, 陳平, 鄭祺, 等.胃癌術后早期應用低分子肝素對靜脈血栓形成的影響.中華普通外科雜志, 2014, 29(011):875-876.
13.	紀烈辰, 俞林.直腸癌術后應用低分子肝素預防靜脈血栓性疾病的價值.中華消化外科雜志, 2013, 12(6):428-430.
14.	Fanikos J, Piazza G, Zayaruzny M, et al. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost, 2009, 102(4):688-693.
15.	Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med, 2006, 355 (17):1780-1789.
16.	邵新宏, 包文.下肢深靜脈血栓手術與溶栓治療效果的比較.中國普外基礎與臨雜志, 2011, 18(12):1309-1313.
17.	馬志強, 魏松洋, 楊瑞麗, 等.下肢深靜脈血栓形成的治療經驗.中國普外基礎與臨床雜志, 2011, 18(2):202-203.

1. Büller HR, Prins MH, Lensing AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366(14):1287-1297.
2. Cheung HY, Chung CC, Yau KK, et al. Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in Chinese patients.Asian J Surg, 2008, 31(2):63-68.
3. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation, 2003, 107(23 Suppl 1):I9-I16.
4. Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer:American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013, 31(17):2189-2204.
5. Smith BR, Diniz S, Stamos M, et al. Deep venous thrombosis after general surgical operations at a university hospital:two-year data from the ACS NSQIP. Arch Surg, 2011, 146(12):1424-1427.
6. Laryea J, Champagne B. Venous thromboembolism prophylaxis. Clin Colon Rectal Surg, 2013, 26(3):153-159.
7. 袁訓芝, 吳新民, 袁家穎, 等.壓力梯度長襪和間歇充氣裝置預防惡性腫瘤患者術后下肢深靜脈血栓形成的效果.中華麻醉學雜志, 2006, 26(2):103-106.
8. Vaitkus PT, Leizorovicz A, Cohen AT, et al. Mortality rates andrisk factors for asymptomatic deep vein thrombosis in medical patients. Thromb Haemost, 2005, 93(1):76-79.
9. Saxena A, Mittal A, Arya SK, et al. Safety and efficacy of low-molecular-weight heparins in prophylaxis of deep vein thrombosis in postoperative/ICU patients:A comparative study. J Nat Sci Biol Med, 2013, 4(1):197-200.
10. Mismetti P, Laporte S, Darmon JY, et al. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolismin general surgery. Br J Surg, 2001, 88 (7):913-930.
11. 陶國全, 葛恒發, 姜寶飛, 等.腹腔鏡結直腸術后并發癥的處理.中華消化外科雜志, 2011, 10(1):47-47.
12. 葉華, 陳平, 鄭祺, 等.胃癌術后早期應用低分子肝素對靜脈血栓形成的影響.中華普通外科雜志, 2014, 29(011):875-876.
13. 紀烈辰, 俞林.直腸癌術后應用低分子肝素預防靜脈血栓性疾病的價值.中華消化外科雜志, 2013, 12(6):428-430.
14. Fanikos J, Piazza G, Zayaruzny M, et al. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost, 2009, 102(4):688-693.
15. Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med, 2006, 355 (17):1780-1789.
16. 邵新宏, 包文.下肢深靜脈血栓手術與溶栓治療效果的比較.中國普外基礎與臨雜志, 2011, 18(12):1309-1313.
17. 馬志強, 魏松洋, 楊瑞麗, 等.下肢深靜脈血栓形成的治療經驗.中國普外基礎與臨床雜志, 2011, 18(2):202-203.

Previous Article
經括約肌間瘺管結扎術治療復雜性肛瘺44例臨床療效觀察
Next Article
腹腔引流管拔除困難的原因分析及處理方法（附22例報道）

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

術后早期應用低分子肝素對胃腸道惡性腫瘤術后深靜脈血栓形成的影響

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content