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论著:肺叶切除术后早期抗凝对出凝血功能的影响
Impact of Anticoagulant Therapy on Hemorrhage and Coagulation Started at Earlier Period after Lung Resection
宣丽真 钟鸣 诸杜明
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作者单位:复旦大学附属中山医院外科监护室
中文关键字:静脉血栓栓塞症;低分子肝素;肺叶切除术;胸管引流量;血栓弹力图
英文关键字:Venous thromboembolism; Low-molecular-weight heparin; Lung resection; Chest drainage; Thrombelastography
中文摘要:目的:了解肺叶切除术后应用低分子肝素抗凝是否增加患者早期出血的风险。方法:选取18例行肺叶切除术患者,随机分为抗凝组与非抗凝组。抗凝组在术后12~24 h开始腹壁皮下注射低分子肝素,每天1次;非抗凝组不给予低分子肝素。所有患者术前查血常规、凝血功能、肝功能、肾功能,麻醉诱导前桡动脉抽血检测血栓弹力图(TEG)。患者术后入外科监护室,查血常规、TEG;术后第1、第2天晨6点查血常规;术后第1天晨9点查TEG。监测术后第1、第2天胸管引流量。结果:用低分子肝素前(即术毕至次晨6点)胸管引流量:抗凝组0~397 mL,平均(189.11±155.71) mL;非抗凝组20~340 mL,平均(256.11±102.86) mL。平均每小时胸引量:抗凝组(9.77±8.03) mL,非抗凝组(14.91±5.99) mL,2组比较无显著差异(P=0.14)。开始用低分子肝素后24h(即术后第1天晨6点至术后第2天晨6点)胸管引流量:抗凝组为45~550 mL,平均(291.11±198.74) mL;非抗凝组为160~530 mL,平均(323.33±121.78) mL;2组比较无显著差异(P=0.68)。抗凝组术后即刻和使用低分子肝素后的TEG各项指标无显著差异(P均 >0.05);非抗凝组术后即刻的TEG各项指标和术后第1天比较均无显著差异(P均>0.05)。2组术前TEG比较和术后第1天的TEG比较均无显著差异(均P>0.05)。抗凝组抗凝后血常规中血红细胞计数较抗凝前平均下降(0.36±0.76)×109/L,非抗凝组平均下降(0.18±0.22)×109/L,2组比较有显著差异(P=0.0001)。结论:肺叶切除术后12~24 h开始应用预防剂量的低分子肝素抗凝并不增加术后早期出血的风险。
英文摘要:Objective: To study whether the use of low molecular weight heparin (LMWH) for thromboprophylaxis will increase the hemorrhage at the earlier period after lung resections. Methods: We randomly assigned 18 patients undergoing lung resections to anticoagulation group and non-anticoagulation group. The anticoagulation group received subcutaneous dose of LMWH(weight≥50kg,0.4ml; weight<50kg, 0.3ml) once daily initiated at 6am on the first day after surgery. Venous blood was collected to determine blood routine, coagulation function, liver and renal function before surgery. Arterial blood was collected to test thrombelastography(TEG) before anesthesia induction. Make blood routine and TEG test after surgery. Make blood routine test at 6am on the first and second day after surgery. Make TEG at 9am on the first day after surgery(3 hours after LMWH was used). Results: There were no difference in chest drainage each hour between two groups(P=0.14) from 12 to 24 hours after surgery. After the use of LMWH, the chest drainage 24 hours had no significant difference between two groups(P=0.68). On the comparison of TEG, there was also no difference. All the P values >0.05.The red blood cell count decreased (0.36±0.76)×109/L in anticoagulation group and (0.18±0.22)×109/L in non-anticoagulation group after the use of LMWH. There was significant difference between the two groups(P=0.0001). Conclusions: The use of LMWH for thromboprophylaxis initiated at the early period(12-24 hour) after lung resections can not increase the risk of early bleeding.
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