序贯加压袜和低分子肝素在预防妇科术后下肢深静脉血栓形成中作用.docVIP

序贯加压袜和低分子肝素在预防妇科术后下肢深静脉血栓形成中作用 　　摘要：目的探讨序贯加压袜(GCS)与低分子肝素（LMWH）预防措施对妇科盆腔术后下肢深静脉血栓形成中高危患者的影响和作用；方法前瞻性随机对照研究164例有血栓中高危险因素的妇科术后患者，随机分成两组后分别使用GCS、GCS+LMWH预防措施，记录患者手术前后血栓相关指标变化、术后下肢血栓、肺栓塞发生率及相关因素；结果GCS组DVT发生率12.8%（11/86），PE发生率8.1%(7/86)， GCS+LMWH组DVT发生率3.8%（3/78），PE发生率1.3%（1/78）；结论GCS+LMWH组预防下肢深静脉血栓及肺栓塞的效果均优于GCS组，两组之间差异有统计学意义（P005）。 　　关键词：下肢深静脉血栓；妇科手术；预防 　　The Prophylaxis for Lower Extremity Deep Venous Thrombosis after Gynecological Pelvic Surgery 　　ZHANG Jian,SANG Cui-qin,ZHAO Na,GUO Shu-li,WANG Shu-zhen,ZHANG Zhen-yu 　　(Department of Obstetrics and Gynecology，The Affiliated of Beijing Chaoyang Hospital，Capital University of Medical Science，Beijing 100020,China) 　　Abstract：ObjectiveTo investigate the effect of lower extremity deep venous thrombosis prophylactics by two preventive methods in DVT high risk patients after gynecological pelvic surgery.Methods This propective randomized study consisted of 164 postoperative patients who were randomly assigned to two groups with high risk of DVT，GCS，GCS+LMWH were used as prophylactics for DVT，and the records of morbidity of DVT,PE and index related thrombosis both pre-operation and post-operation were analyzed.ResultsThe morbidity of DVT in GCS group was 12.8%，the morbidity of PE was 8.1%，the morbidity of DVT in GCS+LMWH group was 3.8%，the morbidity of PE was 1.3%.ConclusionThe effects of prophylaxis of DVT，PE in GCS+LMWH group was more effective than that in GCS group,there were significant statistical differences between the two groups（P005）. 　　Key words：Deep venous thrombosis of lower extremity；Gynecologic surgery；Prevention 　　下肢深静脉血栓（lower extremity venous thrombosis，LEDVT）是妇科手术后常见严重并发症之一[1]，在急性期可因血栓脱落发生肺栓塞（PE），导致患者死亡率与致残率均增加；在慢性期可出现血栓形成后综合征（post-thrombosis syndrome，PTS），长期影响患者术后的生活质量[2]。在我国，妇科盆腔手术后LEDVT的发病率可达15.6%，与国外文献报道相近[3]，因此，对于下肢深静脉血栓形成的中高危患者更应采取积极主动的预防措施。本文探讨应用序贯加压袜(GCS)及序贯加压袜(GCS)联合低分子肝素(LMWH)2种预防方式对中高危患者妇科手术后下肢静脉血栓形成的影响。 　　1资料与方法 　　1.1一般资料研究入组标准：患者自愿配合并签署知情同意书，术前彩色多普勒检查双下肢（-），年龄≥45岁、有DVT或PE病史、有血栓形成倾向（如有