本文選題：中度高海拔 + 肺手術(shù)��； 參考：《廣東醫(yī)學》2016年06期

【摘要】：目的探討肺部手術(shù)后早期使用低分子肝素抗凝對凝血功能的影響及其安全性。方法選取因肺部疾病行肺部手術(shù)的患者共68例,按照隨機數(shù)字表法分為抗凝組和非抗凝組�？鼓M從術(shù)后8 h開始給予皮下注射預(yù)防劑量的低分子肝素2 500 U,1次/d,非抗凝組不給予低分子肝素。所有患者均不使用止血藥物,于麻醉誘導前、術(shù)后11 h(術(shù)后8 h患者病情趨于穩(wěn)定后注射低分子肝素,低分子肝素皮下注射3 h后血藥濃度達到峰值),分別股靜脈采血行血栓彈力圖(TEG)檢測,并監(jiān)測術(shù)后第48小時胸管引流量。結(jié)果抗凝組患者術(shù)后與術(shù)前TEG各項指標(R、K、Alpha、MA)比較差異均無統(tǒng)計學意義(P0.05);非抗凝組患者術(shù)后與術(shù)前TEG比較,R及K值明顯降低,Alpha、MA明顯升高,差異有統(tǒng)計學意義(P0.05);抗凝組與非抗凝組術(shù)后TEG比較,R及K值明顯升高,Alpha、MA明顯降低,差異有統(tǒng)計學意義(P0.05);抗凝組與非抗凝組48 h胸腔引流量比較,差異無統(tǒng)計學意義(P0.05)。結(jié)論中度高海拔地區(qū)肺部手術(shù)后患者血液系統(tǒng)出現(xiàn)了一定程度的高凝狀態(tài)。術(shù)后早期應(yīng)用低分子肝素能改善肺部手術(shù)后出現(xiàn)的高凝狀態(tài)。術(shù)后早期應(yīng)用低分子肝素抗凝治療不會增加術(shù)后出血風險。
[Abstract]:Objective to investigate the effect of low molecular weight heparin (LMWH) anticoagulation on coagulation function and its safety after pulmonary surgery. Methods Sixty-eight patients undergoing pulmonary surgery were randomly divided into anticoagulant group and non-anticoagulant group. The anticoagulant group was given hypodermic injection of low molecular weight heparin (LMWH 2 500 U / d) at 8 hours after operation, while the non-anticoagulant group was not given LMWH. No hemostatic drugs were used in all patients. Low molecular weight heparin (LMWH) was injected at 11 h after anesthesia induction (8 h after operation). The concentration of low molecular weight heparin (LMWH) reached the peak level 3 h after subcutaneous injection. Thromboelastography (TEG) was performed in blood collected from femoral vein, and the drainage volume of thoracic duct was monitored 48 hours after operation. Results in the anticoagulant group, there was no significant difference in the TEG indexes (P 0.05) between the postoperative and preoperative TEG, while in the non-anticoagulant group, the values of TEG, R and K were significantly lower than those before the operation, and the levels of AlphaMA were significantly higher in the non-anticoagulant group than in the preoperative group. There was significant difference in TEG between anticoagulant group and non-anticoagulant group (P 0.05), but there was no significant difference between anticoagulant group and non anticoagulant group in 48 h thoracic drainage volume (P 0.05). Conclusion the hypercoagulable state of the blood system in patients with pulmonary surgery at moderate and high altitude. Early application of low molecular weight heparin (LMWH) can improve the hypercoagulable state after pulmonary surgery. Early application of low molecular weight heparin anticoagulant therapy does not increase the risk of postoperative bleeding.
【作者單位】： 青海省人民醫(yī)院胸外科;
【分類號】：R655.3

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