摘要
目的 探讨预防性应用低分子肝素抗凝及不同时间开始用药对肺癌手术患者的影响。方法 收集2020年9月-2021年12月在我院进行手术治疗的肺癌患者180例，根据其抗凝药物使用情况分为术前抗凝组43例、术后抗凝组79例、未抗凝组58例。比较三组手术时间、术中出血量、术后引流管留置时间、术后总引流量、术后住院时间等术中及术后临床指标及术后血栓性疾病的发生情况；分别于术前、术后第1、2、3、4、5天应用血栓弹力仪对患者进行血栓弹力图检查。结果 术后第1、2、3、4、5天，术前抗凝组、术后抗凝组与未抗凝组R值差异有统计学意义（P＜0.05），其余各指标差异无统计学意义（P＞0.05），术前抗凝组与术后抗凝组各指标差异无统计学意义（P＞0.05）；术前抗凝组、术后抗凝组术后血栓性疾病发生率低于未抗凝组（P＜0.05），术前抗凝组与术后抗凝组术后血栓性疾病发生率差异无统计学意义（P＞0.05）。结论 应用低分子肝素预防性抗凝治疗可降低肺癌手术患者术后静脉血栓形成的风险，术前或术后用药临床效果相当。
关键词： 肺癌；低分子肝素；抗凝治疗；静脉血栓栓塞
Abstract
Objective: To explore the effects of prophylactic anticoagulation with low molecular weight heparin(LMWH) and starting administration at different times on patients with lung cancer surgery. Methods: 180 lung cancer patients who underwent surgical treatment in our hospital from September 2020 to December 2021 were selected and divided into the preoperative anticoagulant group (n=43), the postoperative anticoagulant group (n=79) and the non-anticoagulant group (n=58) according the use of anticoagulant drugs. The intraoperative and postoperative clinical indicators including operative time, intraoperative bleeding, postoperative drainage tube indwelling time, postoperative chest volume and postoperative hospital stay and the incidence of thrombotic disease after surgery were compared among the three groups. Thromboelastogram was examined before surgery and on the 1st, 2nd, 3rd, 4th and 5th day after surgery. Results: On the 1st, 2nd, 3rd, 4th and 5th day after operation, there was significant difference in R value among preoperative anticoagulation group, postoperative anticoagulation group and non-anticoagulation group. There was no significant difference between the other indicators(P＞0.05). The incidence of postoperative thrombotic diseases in the preoperative and postoperative anticoagulant group was lower than that in the non-anticoagulant group (P＜0.05). There was no significant difference in the incidence of postoperative thrombotic diseases between preoperative anticoagulant group and postoperative anticoagulant group(P＞0.05). Conclusion : The use of low-molecular-weight heparin prophylactic anticoagulation therapy can reduce the risk of postoperative venous thrombosis in patients with lung cancer. The clinical value of preoperative or postoperative prophylactic anticoagulation is equivalent.
Key words： Lung cancer; low molecular weight heparin; anticoagulation; Venous thromboembolism
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