【摘要】 目的探讨肝素或低分子肝素抗凝方案应用于颈动脉CASA术后抗凝效果以及安全性,为临床选择抗凝方案提供参考。方法选择2010年1月~2013年12月120例实施颈动脉CASA术患者,按抗凝方案分为对照组与观察组。对照组54例患者实施持续静脉滴注肝素抗凝,抗凝持续3 d;观察组66例患者实施低分子肝素皮下注射抗凝,12 h注射一次,3 d内持续不间断,分别于术前、术后24 h、术后72 h检测两组患者抗-Xa活性、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT),并对比两组患者术后30 d内并发症发生情况。结果观察组与对照组抗-Xa活性水平术后24 h分别为(1.204±0.413)IU/m L、(1.428±0.512)IU/m L,差异有统计学意义(t=3.189,P=0.037),术后72 h观察组与对照组抗-Xa活性水平分别为(1.314±0.533)IU/m L、(1.684±0.687)IU/m L,差异有统计学意义(t=4.218,P=0.030);观察组术前、术后24 h、术后72 h APTT分别为(27.93±3.86)s、(37.97±5.14)s、(37.73±4.28)s,术后与术前对比差异均有统计学意义(t=6.453,P=0.009;t=6.449,P=0.010);对照组术前、术后24 h、术后72 h APTT分别为(27.64±3.24)s、(38.34±4.55)s、(38.21±4.41)s,术后与术前对比差异均有统计学意义(t=6.534,P=0.007;t=6.530,P=0.007);术前、术后24 h、术后72 h同时期对比观察组与对照组差异均无统计学意义(t=0.927,P=0.197;t=1.023,P=0.143;t=0.993,P=0.176);观察组术前、术后24 h、术后72 h PT与对照组对比差异均无统计学意义(P>0.05);观察组并发症发生率[9.09%(6/66)]与对照组[7.41%(4/54)]对比差异无统计学意义(χ2=1.034,P=0.114)。结论低分子肝素与普通肝素应用于颈动脉CASA术后抗凝效果基本一致,低分子肝素抗-Xa活性略低,但肝素方便监测易控制,更容易保证治疗安全性,临床可根据实际需要选择抗凝方案。更多还原

【Abstract】 Objective To investigate anticoagulation and security of heparin and low molecular weight heparin applied to the carotid artery after CASA, to provide a reference for clinical anticoagulation. Methods From January 2010 to December 2013, 120 cases of implementation of CASA surgical patients with carotid artery were selected, according to anticoagulation method they were divided into control group and observation group, control group had 54 patients, the implementation was continuous intravenous infusion of heparin for 3 days; observation group had 66 patients with subcutaneous low molecular weight heparin anticoagulation, one injection for 12 h, lasted for three days, before surgery,24 h, 72 h after surgery, anti-Xa activity were detected in patients, activated partial thromboplastin time(APTT), prothrombin time(PT), complications were compared between the two groups. Results Anti-Xa activity of observation group and control group after 24 h were(1.204±0.413) IU/m L,(1.428±0.512) IU/m L, the difference was statistically significant(t=3.189,P=0.037), anti-Xa activity levels after 72 h of observation group and control group were(1.314±0.533)IU/m L,(1.684±0.687) IU/m L, the difference was statistically significant(t =4.218, P =0.030); in observation group, before surgery, 24 h, 72 h after surgery APTT were(27.93±3.86)s,(37.97±5.14)s,(37.73±4.28)s, differences were statistically significant before and after surgery(t=6.453, P=0.009; t=6.449,P=0.010); in the control group, before surgery,24 h,72 h after surgery APTT were(27.64±3.24)s,(38.34±4.55)s,(38.21±4.41)s,differences were statistically significant before and after surgery(t=6.534,P=0.007; t=6.530, P=0.007); preoperative and 24 h, 72 h postoperative at the same period for observation group and control group there were no significant difference(t=0.927, P=0.197;t=1.023, P=0.143; t=0.993, P=0.176); in observation group before surgery,24 h,72 h after surgery for PT compared with the control group the difference was not statistically significant(P>0.05); in observation group complication rate was 9.09%(6/66) and the control group was 7.41%(4/54) the difference was no statistically significant(χ2=1.034, P=0.114).Conclusion Low molecular weight heparin and unfractionated heparin used in carotid surgery CASA have similar anticoagulant effect, low molecular weight heparin is slightly lower in anti-Xa activity, but it’s easy to monitor and control to ensure the safety of the treatment.更多还原