中度高海拔地区肺部手术后早期使用低分子肝素抗凝对凝血功能的影响及安全性

发布时间：2018-05-21 07:28

本文选题：中度高海拔 + 肺手术　；参考：《广东医学》2016年06期

【摘要】：目的探讨肺部手术后早期使用低分子肝素抗凝对凝血功能的影响及其安全性。方法选取因肺部疾病行肺部手术的患者共68例,按照随机数字表法分为抗凝组和非抗凝组。抗凝组从术后8 h开始给予皮下注射预防剂量的低分子肝素2 500 U,1次/d,非抗凝组不给予低分子肝素。所有患者均不使用止血药物,于麻醉诱导前、术后11 h(术后8 h患者病情趋于稳定后注射低分子肝素,低分子肝素皮下注射3 h后血药浓度达到峰值),分别股静脉采血行血栓弹力图(TEG)检测,并监测术后第48小时胸管引流量。结果抗凝组患者术后与术前TEG各项指标(R、K、Alpha、MA)比较差异均无统计学意义(P0.05);非抗凝组患者术后与术前TEG比较,R及K值明显降低,Alpha、MA明显升高,差异有统计学意义(P0.05);抗凝组与非抗凝组术后TEG比较,R及K值明显升高,Alpha、MA明显降低,差异有统计学意义(P0.05);抗凝组与非抗凝组48 h胸腔引流量比较,差异无统计学意义(P0.05)。结论中度高海拔地区肺部手术后患者血液系统出现了一定程度的高凝状态。术后早期应用低分子肝素能改善肺部手术后出现的高凝状态。术后早期应用低分子肝素抗凝治疗不会增加术后出血风险。
[Abstract]:Objective to investigate the effect of low molecular weight heparin (LMWH) anticoagulation on coagulation function and its safety after pulmonary surgery. Methods Sixty-eight patients undergoing pulmonary surgery were randomly divided into anticoagulant group and non-anticoagulant group. The anticoagulant group was given hypodermic injection of low molecular weight heparin (LMWH 2 500 U / d) at 8 hours after operation, while the non-anticoagulant group was not given LMWH. No hemostatic drugs were used in all patients. Low molecular weight heparin (LMWH) was injected at 11 h after anesthesia induction (8 h after operation). The concentration of low molecular weight heparin (LMWH) reached the peak level 3 h after subcutaneous injection. Thromboelastography (TEG) was performed in blood collected from femoral vein, and the drainage volume of thoracic duct was monitored 48 hours after operation. Results in the anticoagulant group, there was no significant difference in the TEG indexes (P 0.05) between the postoperative and preoperative TEG, while in the non-anticoagulant group, the values of TEG, R and K were significantly lower than those before the operation, and the levels of AlphaMA were significantly higher in the non-anticoagulant group than in the preoperative group. There was significant difference in TEG between anticoagulant group and non-anticoagulant group (P 0.05), but there was no significant difference between anticoagulant group and non anticoagulant group in 48 h thoracic drainage volume (P 0.05). Conclusion the hypercoagulable state of the blood system in patients with pulmonary surgery at moderate and high altitude. Early application of low molecular weight heparin (LMWH) can improve the hypercoagulable state after pulmonary surgery. Early application of low molecular weight heparin anticoagulant therapy does not increase the risk of postoperative bleeding.
【作者单位】：青海省人民医院胸外科;
【分类号】：R655.3

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