Yang Bai-liu, Zhang Zhen-yu, Guo Shu-li
Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing 100020, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Aug;44(8):570-3.
To explore the clinical significance of preventive treatment of thrombosis for patients undergoing gynecological surgeries with high risk factors.
Prospectively, randomized and cases controlled study was performed in 143 patients underwent gynecological surgery with high risk factors to explore the prevention effectiveness and safety in morbidity of lower extremity deep venous thrombosis (LDVT) and relative effected factors, who were enrolled to three groups according to different preventive treatment: group using intermittent pneumatic calf compression (IPC) in 47 cases, group using low-molecular-weight hepairin (LMWH) in 48 cases and control group in 48 cases with no prevention strategy.
The morbidity of LDVT on lower extremity was 6% (6/94) in group IPC and 1% (1/96) in group LMWH, 18% (17/96) in control group, which was obviously reduced in group IPC and group LMWH than that in control group (P < 0.05), while there was no significantly difference between group IPC and group LMWH (P > 0.05). After surgery in 3 or 4 days, the morbidity of LDVT in group IPC was 1/6, zero in group LMWH and 71% (12/17) in control group, there was significantly reduced in group IPC and group LMWH than that in control group (P < 0.05). There was no side-effects in group IPC, only 1 case in group LMWH presented small quantity bleed in vagina remnant, while no incision bleeding and bleed tendency. Single-variate analysis indicated that elder age, abdominal surgeries and malignant tumor were as the independent factors to effect preventive treatment of thrombosis (P < 0.05).
LDVT in patients underwent gynecological surgeries with high risk factors can be obviously reduced and delayed by preventive treatment, which is no side-effects, while be effected by the factors of elder age, abdominal surgeries and malignant tumor.
探讨对具有高危因素的妇科手术患者进行血栓预防治疗的临床意义。
对143例具有高危因素的妇科手术患者进行前瞻性、随机、病例对照研究,根据不同预防治疗措施分为三组:间歇性气动小腿压迫(IPC)组47例,低分子肝素(LMWH)组48例,对照组48例(未采取预防策略),以探讨预防下肢深静脉血栓形成(LDVT)的有效性、安全性及相关影响因素。
IPC组下肢LDVT发生率为6%(6/94),LMWH组为1%(1/96),对照组为18%(17/96),IPC组和LMWH组明显低于对照组(P<0.05),而IPC组与LMWH组之间差异无统计学意义(P>0.05)。术后3或4天时,IPC组LDVT发生率为1/6,LMWH组为零,对照组为71%(12/17),IPC组和LMWH组明显低于对照组(P<0.05)。IPC组无副作用,LMWH组仅1例阴道残端少量出血,无切口出血及出血倾向。单因素分析表明,年龄较大、腹部手术及恶性肿瘤是影响血栓预防治疗的独立因素(P<0.05)。
对具有高危因素的妇科手术患者进行预防治疗可明显降低并延迟LDVT的发生,且无副作用,但受年龄较大、腹部手术及恶性肿瘤等因素影响。