Steinmann E, Duckert F, Gruber U F
Schweiz Med Wochenschr. 1975 Dec 6;105(49):1637-49.
28 prospective, controlled, randomised studies on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in surgical patients on dextran 70 prophylaxis are analysed. In all patients the diagnosis had been established by objective methods (fibrinogen test, phlebography, autopsy). In patients undergoing hip surgery (11 studies, mainly fractures of the upper end of the femur) the reduction in the number of DVT under dextran prophylaxis is the more evident the longer after operation phlebography is carried out. Coumarin and dextran prevention are equally effective. In 3 studies where diagnosis by the fibrinogen test was established during the first postoperative week only, no significant effect of dextran can be shown; there is no difference between the effect of dextran, coumarin or small doses of subcutaneous heparin. The effectiveness of dextran prophylaxis in reducing the DVT rate in general surgery (4 papers) is not clear, though 7 studies show that the number of fatal PE is reduced more than fivefold (p less than 0.0005). In patients on dextran prophylaxis, the incidence of DVT is equal to that in patients on coumarin prophylaxis before major gynecological surgery (4 papers). On postoperative initiation coumarin is significantly less effective than dextran. 2 further studies show that dextran is significantly effective as compared to controls and that there is no difference between dextran and heparin prophylaxis. Out of 1932 control patients 36 died of fatal PE verified at autopsy. Only 8 PE were seen in the group of 2011 patients receiving dextran prophylaxis (p less than 0.005). The effectiveness of dextran 70 corresponds to that of small doses of subcutaneous heparin. Dextran prevention is more effective in women than in men. Dextran prophylaxis is simple to carry out, has few contraindications, only rarely causes complications and is already effective during operation.
分析了28项关于接受右旋糖酐70预防治疗的外科手术患者深静脉血栓形成（DVT）和肺栓塞（PE）发生率的前瞻性、对照、随机研究。所有患者的诊断均通过客观方法（纤维蛋白原试验、静脉造影、尸检）确定。在接受髋关节手术的患者中（11项研究，主要为股骨上端骨折），进行静脉造影的时间距离手术越久，右旋糖酐预防下DVT数量的减少就越明显。香豆素和右旋糖酐预防同样有效。在仅在术后第一周通过纤维蛋白原试验确诊的3项研究中，未显示出右旋糖酐有显著效果；右旋糖酐、香豆素或小剂量皮下肝素的效果无差异。右旋糖酐预防在普外科降低DVT发生率的有效性尚不明确（4篇论文），不过7项研究表明致命PE的数量减少了五倍以上（p小于0.0005）。在接受右旋糖酐预防的患者中，大型妇科手术前DVT的发生率与接受香豆素预防的患者相同（4篇论文）。术后开始使用时，香豆素的效果明显不如右旋糖酐。另外2项研究表明，与对照组相比，右旋糖酐有显著效果，且右旋糖酐和肝素预防之间无差异。在1932名对照患者中，36人死于尸检证实的致命PE。在接受右旋糖酐预防的2011名患者组中，仅发现8例PE（p小于0.005）。右旋糖酐70的效果与小剂量皮下肝素相当。右旋糖酐预防对女性比对男性更有效。右旋糖酐预防实施简单，禁忌症少，很少引起并发症，且在手术期间就已有效。
