本文選題：靜脈血栓 + 預(yù)后��； 參考：《現(xiàn)代婦產(chǎn)科進(jìn)展》2015年02期

【摘要】：目的:探討婦科惡性腫瘤術(shù)后靜脈血栓預(yù)防措施的有效性。方法:選取2008年10月至2014年2月在蘇北人民醫(yī)院行婦科手術(shù)治療的564例婦科惡性腫瘤患者,其中宮頸癌359例、子宮內(nèi)膜癌110例和卵巢癌95例。根據(jù)術(shù)后危險程度分級采取不同的預(yù)防措施。中�；颊�(82例):術(shù)中采用彈力襪對下肢加壓,術(shù)后連續(xù)3天靜脈滴注低分子右旋糖酐500ml/d;高危(90例)和極高�；颊�(392例):術(shù)中采用彈力襪對下肢加壓,并應(yīng)用至術(shù)后1周;術(shù)后第一天靜脈滴注低分子右旋糖酐500ml,術(shù)后第二天皮下注射依諾肝素鈉0.4ml/d,連續(xù)應(yīng)用5天。比較低分子右旋糖酐、低分子肝素及彈力襪不同聯(lián)合方法對術(shù)后靜脈血栓的預(yù)防效果。結(jié)果:564例患者中30例發(fā)生靜脈血栓栓塞(VTE),其中深靜脈血栓(DVT)22例(3.9%),肺栓塞(PE)2例(0.4%)、DVT合并PE 6例(1.1%)。宮頸癌、子宮內(nèi)膜癌和卵巢癌患者術(shù)后發(fā)生VTE者分別有16例、8例和6例,3組比較差異均無統(tǒng)計學(xué)意義(P0.05)。564例婦科惡性腫瘤患者中40歲者術(shù)后無VTE發(fā)生,40~49歲、50~59歲和60歲患者中術(shù)后發(fā)生VTE者分別有5例、12例和13例,3組比較差異有統(tǒng)計學(xué)意義(P=0.027)。中危、高危、極高�；颊叩男g(shù)后靜脈血栓發(fā)生率分別為3.7%、4.4%和5.8%,3組比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:低分子右旋糖酐、低分子肝素及彈力襪可有效預(yù)防患者術(shù)后靜脈血栓的發(fā)生。根據(jù)患者不同的危險程度,選用不同方法預(yù)防,可避免過度治療,降低術(shù)后出血。
[Abstract]:Objective: to investigate the effectiveness of preventive measures for postoperative venous thrombosis in gynecological malignant tumors. Methods: from October 2008 to February 2014, 564 patients with gynecological malignant tumors were treated by gynecological surgery in Subei people's Hospital, including 359 cases of cervical cancer, 110 cases of endometrial carcinoma and 95 cases of ovarian cancer. Different preventive measures were taken according to the grade of risk after operation. Eighty-two cases of moderate risk patients were treated with elastic socks for lower extremity compression during operation and intravenous drip of low-molecular-weight dextran 500ml / d (90 cases) and extremely high risk patients (392cases) for 3 days after operation. During the operation, elastic socks were used to compress the lower extremities and applied to 1 week after operation. Low molecular weight dextran 500 ml was injected intravenously on the first day after operation, followed by subcutaneous injection of enoxaparin sodium 0.4 ml / d for 5 days. The preventive effects of low molecular weight dextran, low molecular weight heparin and elastic socks on postoperative venous thrombosis were compared. Results VTET was found in 30 out of 564 patients, including DVT in 22 patients with DVT and PEI in 2 patients with PE in 6 patients. Cervical cancer, There were 16 cases of endometrial carcinoma and 6 cases of ovarian cancer developed VTE after operation. There was no significant difference among the 3 groups. There was no significant difference between 40 years old patients with 40 years old and 60 years old patients of 50 ~ 59 years old and 60 years old in 40 years old patients with gynecological malignant tumor. There were 5 cases with VTE and 13 cases with VTE after operation. The difference was statistically significant (P < 0. 027). The incidence of postoperative venous thrombosis in patients with moderate risk, high risk and very high risk was 3.4% and 5.8%, respectively. There was no significant difference among the three groups (P 0.05). Conclusion: low molecular weight dextran, low molecular weight heparin and elastic socks can effectively prevent postoperative venous thrombosis. According to the different degree of risk, different methods of prevention can avoid overtreatment and reduce postoperative bleeding.
【作者單位】： 揚州大學(xué)臨床醫(yī)學(xué)院婦產(chǎn)科;蘇北人民醫(yī)院婦產(chǎn)科;
【分類號】：R737.3

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