D-二聚体监测及低分子肝素钠的预防在妇科术后静脉血栓性疾病的应用
D-dimer Monitoring and Application of Low Molecular Weight Heparin in Prevention of Venous Thrombotic Disease after Gynecological Operation
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摘要: 目的 对有静脉血栓形成高危因素的妇科术后患者,通过监测术后D-二聚体含量以预测血栓的发生,对D-二聚体含量明显升高患者,予预防性使用低分子肝素钠,以降低血栓发生.方法 选取2014年5月至2016年5月具有VTE发病高危因素的妇科术后患者62例,研究组32例,对照组30例,术后监测2组患者不同时间点D-二聚体含量,即术后第1天、第2天、第3天以及术后第7天的D-二聚体含量,研究组术后24~72h后若D-二聚体含量≥5μg/mL,予低分子肝素钠4 000 IU皮下注射,每日1次,预防静脉血栓形成,连续用药5~7 d.对照组只监测D-二聚体含量,不予预防性注射低分子肝素钠.结果研究组与对照组术后D-二聚体含量均较术前上升,研究组15例D-二聚体含量≥5μg/mL,发生血栓2例,对照组13例D-二聚体含量≥5μg/mL,发生血栓9例,血栓发生率分别为13.33%及69.23%,2组间差异有统计学意义(P<0.05).结论 术后监测D-二聚体含量明显升高且≥5μg/mL的患者,术后血栓发生风险增高,术后监测D-二聚体含量预测血栓形成是有临床价值的;对于D-二聚体含量明显升高且≥5μg/mL的患者,预防性注射低分子肝素钠治疗,预防静脉血栓形成是有效的,能降低血栓的发生率.Abstract: Objective To predict the incidence of thrombosis through monitoring the post-operation D-dimer level in patients with high risky factors of venous thrombosis,and to reduce the incidence of thrombosis by adopting low molecular weight heparin on patients with an obvious rise of post-operation D-dimer level.Methods62 patients with high risk of VTE factors after gynecological operations from May 2014 to May 2016 were selected and dividedinto 2 groups, 32 patients in study group and 30 patients in comparison group. We monitored the D-dimer levels of both groups at different time points,respectively 1, 2, 3 and 7 days after operations. Any patient in the study group had a D-dimer content ≥ 5 μg/mL within 24-72 hours post-operation,was given hypodermic injection of 4 000 IU enoxaparin sodium once a day for a consecutive 5-7 days to prevent venous thrombosis.In the comparison group, only monitor their D-dimer levels without giving prophylactic injection of enoxaparin sodium.Results Post-operation D-dimer levels in both the study group and the comparison group were higher than those before operations. In the study group, 15 cases of D-dimer level≥5 μg/mL and 2 cases of thrombosis occurred, while in the comparison group 13 cases of D-dimer level≥5ug/ml and 9 cases of thrombosis occurred. The incidence of thrombosis was 13.33% and 69.23%, respectively, the difference had a statistical significance(p <0.05).Conclusions Patients with a significantly higher D-dimer leve land ≥ 5ug/ml after operations are more likely to occur post-operationthrombosis. Monitoring of post-operation D-dimer levelhas a clinical value on predicting thrombosis; prophylactic injection of enoxaparin sodium on patients with a significantly higher D-dimer level and ≥ 5μg/mL is effective to prevent venous thrombosis and thus reduce the incidence of thrombotic disease.
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