摘要
目的分析预防性抗凝对下肢静脉曲张术后不同血栓风险分级患者的疗效。方法收集2017年1月至2020年12月于德州市人民医院行手术治疗的360例下肢静脉曲张患者的临床资料。根据改良Wells血栓风险评估量表将360例患者分为低危风险(n=167)、中危风险(n=131)及高危风险(n=62);不同血栓风险患者根据术后处理方式不同分为抗凝组及对照组。术后第4天观察血栓发生、出血情况。比较不同血栓风险的两组患者血栓发生率、出血发生率及术后第4天凝血指标[红细胞计数、血小板计数、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)和D-二聚体]。结果中、高危风险的对照组患者血栓发生率高于抗凝组患者,差异有统计学意义(P<0.05),中、高危风险的两组患者出血发生率比较,差异无统计学意义(P>0.05)。术后第4天,不同血栓风险的两组患者红细胞计数、血小板计数比较,差异无统计学意义(P>0.05);低危风险的两组患者D-二聚体、PT和APTT比较,差异无统计学意义(P>0.05);中、高危风险的抗凝组患者D-二聚体低于对照组患者,PT和APTT长于对照组患者,差异有统计学意义(P<0.05)。结论下肢静脉曲张术后抗凝治疗可有效降低静脉血栓发生率,尤其在中高危患者中效果显著,且未显著增加出血发生率;低危患者可单纯给予物理方法预防。
Objective To explore the effect of preventive anticoagulation on patients with different thrombosis risk grades after lower extremity varicose vein surgery.Method The clinical data of 360 patients with varicose veins of the lower extremities who underwent surgical treatment at Dezhou People's Hospital from January 2017 to December 2020 were collected.According to the modified Wells clinical score for deep venous thrombosis,all patients were divided into a low-risk group(n=167),a middle-risk group(n=131),and a high-risk group(n=62).According to varying postoperative regimens,patients with different thrombosis risks were divided into the anticoagulant group and control group.And the occurrence of thrombosis and bleeding on the 4th day after operation were observed.The incidence of thrombus,incidence of bleeding,and coagulation indexes on the 4th day after the operation of the two groups of patients with different thrombosis risks[red blood cell count,platelet count,prothrombin time(PT),partial prothrombin time(APTT)and D-dimer]were also compared.Result The incidence of thrombosis in the middle-and high-risk control group was higher than that in the anticoagulation group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of bleeding between the two groups in the middle-and high-risk groups(P>0.05).Four days after surgery,there was no significant difference in red blood cell count and platelet count between the two groups of patients with different thrombosis risks(P>0.05).There was no significant difference in D-dimer,PT,and APTT between the two groups of patients at low risk(P>0.05).The D-dimer in the anticoagulant group with middle-and high-risk was lower than the control group,and the PT and APTT were longer than the control group,the difference was statistically significant(P<0.05).Conclusion Anticoagulant therapy after lower extremity varicose veins surgery could effectively reduce the incidence of venous thrombosis,especially in middle-to-high risk patients,without significantly increasing the incidence of bleeding.There was no significant improvement in low-risk patients,and these patients could be prevented by physical methods alone.
作者
庞林宾
马隽
李树强
侯向前
王峰
任占康
李健敏
Pang Linbin;Ma Jun;Li Shuqiang;Hou Xiangqian;Wang Feng;Ren Zhankang;Li Jianmin(Department of Vascular Surgery,Dezhou People's Hospital,Dezhou 253012,Shandong,China;Department of Ultrasound Medicine,Dezhou People's Hospital,Dezhou 253012,Shandong,China;Department of Oncology,Dezhou People's Hospital,Dezhou 253012,Shandong,China)
出处
《血管与腔内血管外科杂志》
2021年第4期438-441,471,共5页
Journal of Vascular and Endovascular Surgery
关键词
抗凝
静脉曲张
血栓形成
出血
anticoagulation
varicosity
thrombosis
hemorrhage
作者简介
庞林宾,主治医师,主要从事血管外科疾病的临床研究,德州市人民医院;通信作者:李健敏,主治医师,E-mail:hellohaoyun123456@126.com。
