中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
4期
299-302
,共4页
静脉血栓形成%阿司匹林%肝素,低分子量%高血压,门静脉
靜脈血栓形成%阿司匹林%肝素,低分子量%高血壓,門靜脈
정맥혈전형성%아사필림%간소,저분자량%고혈압,문정맥
Venous thrombosis%Aspirin%Heparin,low molecular weight%Hypertension,portal
目的 探讨早期应用阿司匹林联合低分子肝素钙预防断流术后门静脉血栓(PVT)形成的疗效.方法 将90例肝硬化门静脉高压症患者分成两组(对照组44例,观察组46例),均行脾切除+贲门周围血管离断术,自术后当天开始观察,发现腹腔和胃肠引流液中不含血性液时,观察组开始皮下注射低分子肝素钙4100 IU/d,10 d.两组均于PLT>300×10~9/L时开始静脉滴注低分子右旋糖酐500ml/d,7～14d;口服肠溶阿司匹林100ms/d,直至PLT恢复正常.术后每周行腹部超声检查1次,连续3周以评价PVT形成情况.结果观察组在断流术后PVT发生率(7%)明显低于对照组(27%)(X~2=6.972,P<0.05);观察组术后并发症发生率(7%)明显低于对照组(32%)(X~2=9.393,P<0.01);观察组术后病死率(2%)明显低于对照组(18%)(X~2=4.748,P<0.05);观察组住院时间(18±7)d明显少于对照组(31±12)d(t=6.311,P<0.01);两组外周血PLT计数自术后第1天开始至术后60 d相比差异无统计学意义(P>0.05);两组术后2周内凝血酶原时间相比差异无统计学意义(P>0.05);两组术后2周内部分凝血酶原时间相比差异无统计学意义(P>0.05);因使用抗凝药物引发皮下出血等不良反应:对照组0例,观察组2例(X~2=0.558,P>0.05).结论 早期应用阿司匹林联合低分子肝素钙预防断流术后PVT形成是一种安全有效的方法.
目的 探討早期應用阿司匹林聯閤低分子肝素鈣預防斷流術後門靜脈血栓(PVT)形成的療效.方法 將90例肝硬化門靜脈高壓癥患者分成兩組(對照組44例,觀察組46例),均行脾切除+賁門週圍血管離斷術,自術後噹天開始觀察,髮現腹腔和胃腸引流液中不含血性液時,觀察組開始皮下註射低分子肝素鈣4100 IU/d,10 d.兩組均于PLT>300×10~9/L時開始靜脈滴註低分子右鏇糖酐500ml/d,7～14d;口服腸溶阿司匹林100ms/d,直至PLT恢複正常.術後每週行腹部超聲檢查1次,連續3週以評價PVT形成情況.結果觀察組在斷流術後PVT髮生率(7%)明顯低于對照組(27%)(X~2=6.972,P<0.05);觀察組術後併髮癥髮生率(7%)明顯低于對照組(32%)(X~2=9.393,P<0.01);觀察組術後病死率(2%)明顯低于對照組(18%)(X~2=4.748,P<0.05);觀察組住院時間(18±7)d明顯少于對照組(31±12)d(t=6.311,P<0.01);兩組外週血PLT計數自術後第1天開始至術後60 d相比差異無統計學意義(P>0.05);兩組術後2週內凝血酶原時間相比差異無統計學意義(P>0.05);兩組術後2週內部分凝血酶原時間相比差異無統計學意義(P>0.05);因使用抗凝藥物引髮皮下齣血等不良反應:對照組0例,觀察組2例(X~2=0.558,P>0.05).結論 早期應用阿司匹林聯閤低分子肝素鈣預防斷流術後PVT形成是一種安全有效的方法.
목적 탐토조기응용아사필림연합저분자간소개예방단류술후문정맥혈전(PVT)형성적료효.방법 장90례간경화문정맥고압증환자분성량조(대조조44례,관찰조46례),균행비절제+분문주위혈관리단술,자술후당천개시관찰,발현복강화위장인류액중불함혈성액시,관찰조개시피하주사저분자간소개4100 IU/d,10 d.량조균우PLT>300×10~9/L시개시정맥적주저분자우선당항500ml/d,7～14d;구복장용아사필림100ms/d,직지PLT회복정상.술후매주행복부초성검사1차,련속3주이평개PVT형성정황.결과관찰조재단류술후PVT발생솔(7%)명현저우대조조(27%)(X~2=6.972,P<0.05);관찰조술후병발증발생솔(7%)명현저우대조조(32%)(X~2=9.393,P<0.01);관찰조술후병사솔(2%)명현저우대조조(18%)(X~2=4.748,P<0.05);관찰조주원시간(18±7)d명현소우대조조(31±12)d(t=6.311,P<0.01);량조외주혈PLT계수자술후제1천개시지술후60 d상비차이무통계학의의(P>0.05);량조술후2주내응혈매원시간상비차이무통계학의의(P>0.05);량조술후2주내부분응혈매원시간상비차이무통계학의의(P>0.05);인사용항응약물인발피하출혈등불량반응:대조조0례,관찰조2례(X~2=0.558,P>0.05).결론 조기응용아사필림연합저분자간소개예방단류술후PVT형성시일충안전유효적방법.
Objective To evaluate the effect of early aspirin combined with low molecular weight heparin calcium in prevention of portal system thrombosis after portaazygous disconnection in patients of portal hypertension.Methods In this study.90 cases with cirrhotic portal hypertension were divided randomly into two groups(control group:44 cases,observation group:46 cases),after standard splenectomy and pericardial devascularization.On the day when abdominal and gastrointestinal drain was not bloody(at 2-5d,mean 3d after operation),low molecular weight heparin calcium 4100 IU per day was given to observation group by subcutaneous injection for 10 days.During treatment,blood platelet(PLT)count was monitored.When PLT in both groups>300 ×10~9/L.low molecular dextran 500 ml per day was given by iv drip for 7-14 days,oral enteric aspirin 100 ms/day was given,until PLT reached normal range.Portal venous thrombosis was evaluated by color Doppler ultrasonography weekly for 3 weeks.Results Postoperative incidence of portal vein thrombosis in observation group(7%)was lower significantly than that in control group(27%)(X~2=6.972,P<0.05).Incidence of postoperative complications in observation group(7%)were lower significantly than that in control group(32%)(X~2=9.393,P<0.01).Mortality rate in observation group(2%)were lower significantly than that of control group(18%)(X~2=4.748.P<0.05).There was no significant difference between the two groups in blood platelet count during observation(P>0.05).Prothrombin time,active pact thromboplastin time were also similar in the two groups(P>0.05).Side effect such as self-limited subcutaneous hemorrhage developed in no cases in control group compared to two cases in observation group(X~2=0.558,P>0.05).Conclusion It is a safe and effective method to use early aspirin combined with low molecular weight heparin in the prevention of portal system thrombosis after splenectomy and portaazygous devascularization in cirrhotic portal hypertensive patients.
