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目的:探讨低分子肝素用于普外科围手术期抗凝治疗预防肺栓塞的临床疗效。方法:1 146例普外手术病例根据术后抗凝与否分为两组。2005年1月～2008年8月,大、中型手术未行抗凝治疗组743例;2006年1月～2008年11月普外科手术后预防性抗凝组,肺栓塞风险分级≥中危病例403例。予低分子肝素5 000IU(中危病例142例)或10 000IU(高危261例)皮下注射预防性抗凝治疗。结果:未行抗凝治疗组发生急性肺栓塞7例,死亡5例,存活2例。术后低分子肝素预防性抗凝403例,并发出血3例(0.7%),无肺栓塞病例。低分子肝素预防性抗凝后PE发生率从0.9%降到0(P<0.05),肺栓塞死亡率差异无统计学意义。结论:对普外科手术后肺栓塞中、高危患者行预防性低分子肝素抗凝治疗,安全有效。
Objective: To investigate the clinical effect of low molecular weight heparin in the prevention and treatment of pulmonary embolism by general surgery perioperative anticoagulation. Methods: One hundred and forty-six cases of general surgery were divided into two groups according to the postoperative anticoagulation or not. From January 2005 to August 2008, there were 743 cases of no major anticoagulation therapy in large and medium-sized surgery; from January 2006 to November 2008, the patients with prophylactic anticoagulation after general surgery, risk classification of pulmonary embolism ≥ middle-risk cases 403 cases. Preventive anticoagulant therapy was given subcutaneously at a low molecular weight heparin of 5 000 IU (142 in intermediate-risk patients) or 10 000 IU (261 in high-risk patients). Results: There were 7 cases of acute pulmonary embolism without anticoagulant therapy, 5 died and 2 cases survived. Postoperative low molecular weight heparin preventive anticoagulation in 403 cases, 3 cases of bleeding (0.7%), no cases of pulmonary embolism. Preventive anticoagulation of low molecular weight heparin after PE decreased from 0.9% to 0 (P <0.05), pulmonary embolism mortality was no significant difference. Conclusion: It is safe and effective to prevent low molecular weight heparin anticoagulant therapy in high risk patients with pulmonary embolism after general surgery.