妇科术后深静脉血栓的预防及治疗
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摘要
目的运用G-Caprini(gynecological caprini)血栓风险评估模型对妇科手术后患者进行深静脉血栓(deep venous thrombosis,DVT)风险分级,对评分达到中危以上的患者,比较单独采用下肢间歇性气囊加压(intermittent pneumatic compression,IPC),或联合低分子量肝素钙(low molecular weight heparin,LMWH)预防DVT的效果。方法选择南京市第二医院2017年9月—2018年9月收治的92例Caprini评分≥2分,有DVT危险因素的妇科术后患者,使用IPC(对照组42例)或IPC+LMWH(观察组50例)预防血栓措施后,检测所有患者术后第2天、第5天D-二聚体;术后第5天行下肢血管加压超声检查(compression ultrasound,CUS),统计2组患者术后DVT的发生率。结果 92例术后患者预防血栓治疗后发生了9例DVT,发生率为9.78%,观察组DVT的发生率为4.00%(2例),明显低于对照组的16.67%(7例),差异具有统计学意义(P <0.05)。观察组术后第5天的D-二聚体明显低于对照组,差异具有统计学意义(P <0.05)。结论下肢间歇性气囊加压+低分子量肝素钙(IPC+LMWH)可以更加有效地减少妇科手术后下肢深静脉血栓发生,D-二聚体可以动态监测DVT消长。
Objective To evaluate and reduce the risk of deep venous thrombosis(DVT) after gynecological surgery,GCaprini(gynecological caprini) risk classification was used to select preventive measures,and to investigate the effects of intermittent pneumatic compression(IPC) and low molecular weight heparin(LMWH) on DVT prevention in patients with medium-high risk.Methods This case control study consisted of ninety-two postoperative patients with mediumhigh risk of DVT with rating scale of G-Caprini(G-Caprini score is greater than 1),ICP or/and LMVH were used to prevent postoperative DVT.D-dimer detection was performed on day 2 and day 5 in all patients,ultrasound examination of vascular compression of lower extremity was performed on the fifth day after surgery.The incidence of DVT after operation was calculated for the two groups.Results There were 2 cases of DVT in the observation group(IPC + LMWH)and the incidence was 4.00%.However,in the control group(IPC),there were 7 cases of deep venous thrombosis,and the incidence rate was 16.67%.The incidence of DVT in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P < 0.05).The d-polymer was significantly lower than the control group for the 5 th day after surgery,and the difference was statistically significant(P < 0.05).Conclusion Low molecular heparin(IPC + LMWH) can reduce the incidence of deep venous thrombosis after gynecological peration.Ddimer can monitor DVT fluctuation dynamically.
Objective To evaluate and reduce the risk of deep venous thrombosis(DVT) after gynecological surgery,GCaprini(gynecological caprini) risk classification was used to select preventive measures,and to investigate the effects of intermittent pneumatic compression(IPC) and low molecular weight heparin(LMWH) on DVT prevention in patients with medium-high risk.Methods This case control study consisted of ninety-two postoperative patients with mediumhigh risk of DVT with rating scale of G-Caprini(G-Caprini score is greater than 1),ICP or/and LMVH were used to prevent postoperative DVT.D-dimer detection was performed on day 2 and day 5 in all patients,ultrasound examination of vascular compression of lower extremity was performed on the fifth day after surgery.The incidence of DVT after operation was calculated for the two groups.Results There were 2 cases of DVT in the observation group(IPC + LMWH)and the incidence was 4.00%.However,in the control group(IPC),there were 7 cases of deep venous thrombosis,and the incidence rate was 16.67%.The incidence of DVT in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P < 0.05).The d-polymer was significantly lower than the control group for the 5 th day after surgery,and the difference was statistically significant(P < 0.05).Conclusion Low molecular heparin(IPC + LMWH) can reduce the incidence of deep venous thrombosis after gynecological peration.Ddimer can monitor DVT fluctuation dynamically.
引文
[1]Barber EL,Clarke-Pearson DL.Prevention of Venous Thromboembolism in Gynecologic Oncology Surgery[J].Gynecol Oncol,2017,144(2):420-427.
[2]Yamada N,Hanzawa K,Ota S,et al.Occurrence of Deep Vein Thrombosis among Hospitalized Non-Surgical Japanese Patients[J].Ann Vasc Dis,2015,8(3):203-209.
[3]Shigemi D,Matsuhashi T,Yamada T,et al.Preoperative screening of thromboembolism using plasma D-dimer test and proximal vein compression ultrasonography in Japanese gynecologic patients[J].Ann Med Surg(Lond),2017,15:52-55.
[4]Matsuo H,Nakajima Y,Ogawa T,et al.Evaluation of D-Dimer in Screening Deep Vein Thrombosis in Hospitalized Japanese Patients with Acute Medical Diseases/Episodes[J].Ann Vasc Dis,2016,9(3):193-200.
[5]Barber EL,Clarke-Pearson DL.The Limited Utility of Currently Available Venous Thromboembolism Risk Assessment Tools in Gynecologic Oncology Patients[J].Am J Obstet Gynecol,2016,215(4):445.e1-445.e9.
[6]Sheth RA,Niekamp A,Quencer KB,et al.Thrombosis in cancer patients:etiology,incidence,and management[J].Cardiovasc Diagn T-her,2017,7(Suppl 3):S178-S185.
[7]娄英华,沈怡.Caprini血栓风险评估模型预测妇科恶性肿瘤手术患者DVT风险的有效性研究[J].东南大学学报(医学版),2017,36(3):333-337.
[8]Qu H,Li Z,Zhai Z,et al.Predicting of Venous Thromboembolism for Patients Undergoing Gynecological Surgery[J].Medicine(Baltimore),2015,94(39):e1653.
[9]郎景和,王辰,瞿红,等.妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志,2017,52(10):649-653.
[10]Feng JP,Xiong YT,Fan ZQ,et al.Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery:A systematic review and meta-analysis[J].Oncotarget,2017,8(12):20371-20379.
[11]张震宇.妇科恶性肿瘤术后下肢深静脉血栓形成的特点与预防[J].实用妇产科杂志,2014,30(9):650-651.
[12]Halaby R,Popma CJ,Cohen A,et al.D-Dimer elevation and adverse outcomes[J].J Thromb Thrombolysis,2015,39(1):55-59.
[13]Corr BR,Winter AM,Sammel MD,et al.Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery[J].Gynecol Oncol,2015,138(3):501-506.
[14]Swenson CW,Berger MB,Kamdar NS,et al.Risk factors for venous thromboembolism after hysterectomy[J].Obstet Gynecol,2015,125(5):1139-1144.
[15]Ye S,Zhang W,Yang J,et al.Pattern of Venous Thromboembolism Occurrence in Gynecologic Malignancy:Incidence,Timing,and Distribution a 10-Year Retrospective Single-institutional Study[J].Medicine(Baltimore),2015,94(50):e2316.
[16]Elyamany G,Alzahrani AM,Bukhary E.Cancer-associated thrombosis:an overview[J].Clin Med Insights Oncol,2014,8:129-137.
[17]Streiff MB.Thrombosis in the setting of cancer[J].Hematology Am Soc Hematol Educ Program,2016,2016(1):196-205.
[2]Yamada N,Hanzawa K,Ota S,et al.Occurrence of Deep Vein Thrombosis among Hospitalized Non-Surgical Japanese Patients[J].Ann Vasc Dis,2015,8(3):203-209.
[3]Shigemi D,Matsuhashi T,Yamada T,et al.Preoperative screening of thromboembolism using plasma D-dimer test and proximal vein compression ultrasonography in Japanese gynecologic patients[J].Ann Med Surg(Lond),2017,15:52-55.
[4]Matsuo H,Nakajima Y,Ogawa T,et al.Evaluation of D-Dimer in Screening Deep Vein Thrombosis in Hospitalized Japanese Patients with Acute Medical Diseases/Episodes[J].Ann Vasc Dis,2016,9(3):193-200.
[5]Barber EL,Clarke-Pearson DL.The Limited Utility of Currently Available Venous Thromboembolism Risk Assessment Tools in Gynecologic Oncology Patients[J].Am J Obstet Gynecol,2016,215(4):445.e1-445.e9.
[6]Sheth RA,Niekamp A,Quencer KB,et al.Thrombosis in cancer patients:etiology,incidence,and management[J].Cardiovasc Diagn T-her,2017,7(Suppl 3):S178-S185.
[7]娄英华,沈怡.Caprini血栓风险评估模型预测妇科恶性肿瘤手术患者DVT风险的有效性研究[J].东南大学学报(医学版),2017,36(3):333-337.
[8]Qu H,Li Z,Zhai Z,et al.Predicting of Venous Thromboembolism for Patients Undergoing Gynecological Surgery[J].Medicine(Baltimore),2015,94(39):e1653.
[9]郎景和,王辰,瞿红,等.妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志,2017,52(10):649-653.
[10]Feng JP,Xiong YT,Fan ZQ,et al.Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery:A systematic review and meta-analysis[J].Oncotarget,2017,8(12):20371-20379.
[11]张震宇.妇科恶性肿瘤术后下肢深静脉血栓形成的特点与预防[J].实用妇产科杂志,2014,30(9):650-651.
[12]Halaby R,Popma CJ,Cohen A,et al.D-Dimer elevation and adverse outcomes[J].J Thromb Thrombolysis,2015,39(1):55-59.
[13]Corr BR,Winter AM,Sammel MD,et al.Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery[J].Gynecol Oncol,2015,138(3):501-506.
[14]Swenson CW,Berger MB,Kamdar NS,et al.Risk factors for venous thromboembolism after hysterectomy[J].Obstet Gynecol,2015,125(5):1139-1144.
[15]Ye S,Zhang W,Yang J,et al.Pattern of Venous Thromboembolism Occurrence in Gynecologic Malignancy:Incidence,Timing,and Distribution a 10-Year Retrospective Single-institutional Study[J].Medicine(Baltimore),2015,94(50):e2316.
[16]Elyamany G,Alzahrani AM,Bukhary E.Cancer-associated thrombosis:an overview[J].Clin Med Insights Oncol,2014,8:129-137.
[17]Streiff MB.Thrombosis in the setting of cancer[J].Hematology Am Soc Hematol Educ Program,2016,2016(1):196-205.
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