【摘要】 目的探讨早期应用低分子肝素对胸腹腔肿瘤术后肺栓塞(PE)的预防效果。方法选取2013年8月—2016年5月于福建莆田学院附属医院胸心外科和普通外科行胸腹腔肿瘤手术患者384例,随机分为对照组198例与研究组186例。研究组患者术后24 h予以低分子肝素治疗,对照组患者术后未予以低分子肝素治疗。比较两组患者术前及术后第2、6天D-二聚体水平和凝血酶原时间(PT),PE发生情况、治愈情况、病死情况,两组患者术后出血情况及不良反应/并发症发生情况。结果时间与方法在D-二聚体上存在交互作用(P<0.05);时间在D-二聚体上主效应显著(P<0.05);方法在D-二聚体上主效应显著(P<0.05);术后第6天研究组患者D-二聚体水平低于对照组(P<0.05)。时间与方法在PT上无交互作用(P>0.05);时间在PT上主效应不显著(P>0.05);方法在PT上主效应显著(P<0.05);研究组患者术后第6天PT长于对照组(P<0.05)。研究组患者PE发生率、病死率低于对照组(P<0.05);两组PE患者治愈率比较,差异无统计学意义(P>0.05)。两组患者术后少量出血、大量出血发生率比较,差异无统计学意义(P>0.05)。两组患者均未发生严重不良反应/并发症。结论早期应用低分子肝素可有效降低胸腹腔肿瘤术后患者PE发生率及病死率,且未增加术后出血发生风险。更多还原

【Abstract】 Objective To evaluate the preventive effect on pulmonary embolism of early application of low molecular weight heparin in postoperative patients undergoing thoracicoabdominal carcinoma operation. Methods From August 2013 to May 2016 in the Department of Cardiothoracic Surgery and Department of General Surgery,the Affiliated Hospital of Putian College,a total of 384 postoperative patients undergoing thoracicoabdominal carcinoma operation were selected,and they were randomly divided into control group( n = 198) and study group( n = 186). Patients of study group received low molecular weight heparin after 24 hours of operation,while patients of control group did not receive low molecular weight heparin. D-dimer and PT before treatment,after 2 days and 6 days of treatment,incidence of pulmonary embolism,cure rate of pulmonary embolism,fatality rate of pulmonary embolism, incidence of adverse reactions / complications were compared between the two groups. Results There was interaction between time and method in D- dimer( P < 0. 05); the main effects of time and method were significant in D- dimer( P < 0. 05); D- dimer of study group was statistically significantly lower than that of control group after 6 days of treatment( P < 0. 05). There was no interaction between time and method in PT( P > 0. 05); the main effect of time was not significant in PT( P > 0. 05),while the main effect of method was significant in PT( P < 0. 05); PT of study group was statistically significantly longer than that of control group after 6 days of treatment( P < 0. 05). Incidence of pulmonary embolism and fatality rate of study group were statistically significantly lower than those of control group( P < 0. 05),while no statistically significant differences of cure rate of pulmonary embolism was found between the two groups( P > 0. 05). No statistically significant differences of incidence of mild bleeding or massive bleeding was found between the two groups( P >0. 05). No one of the two groups occurred any severe adverse reactions / complications. Conclusion Early application of low molecular weight heparin can effectively reduce the incidence of pulmonary embolism and fatality rate in postoperative patients undergoing thoracicoabdominal carcinoma operation,without increasing the risk of bleeding.更多还原