论文部分内容阅读
小剂量肝素和低分子量肝素(LMWH)预防性应用,可明显减少静脉血栓栓塞并发症的发生,但这一效果未见于放疗和化疗等非手术治疗的肿瘤病人,在后者血栓形成仍然是最常见的并发症和第二位常见死亡原因;在临床上也未普遍开展这方面预防措施,现证实LMWH使用简便而有效,应列为首选药物.现已阐明癌肿病人中高凝状态的机制:(1)出现癌肿前凝血质,激活凝血联级反应中因子X;(2)集合细胞表面凝血酶原酶复合物,转换非活性凝血酶原为凝血酶;(3)表达细胞表面组织因子(TF),肿瘤分化越差,TF的表达越大而引起高凝状态.凝血系统的激活是肿瘤生物学的重要一面,恶性肿瘤诊断后2年内,8%病人发生自发性静脉血栓形成,恶性肿瘤术后血栓形成的发生比良性疾病手术后高出3倍.传统的小剂量肝素预防可减少该危机达80%,但需每日注射2～3次,不受欢迎.LMWH只需每日使用一次,是其优点.在一多中心组3809例手术中(40%为癌肿),LMWH和标准肝素治疗的致死性肺栓塞率均为0.7%,但LMWH的重大出血并发症为1.0%,而标准肝素组为1.9%(P=0.02).另在一组2097例手术中(63%为癌肿)比较高剂量(每日5000 U)和低剂量LMWH的结果,高剂量方案减少深静脉血栓形成12.6%至6.7%(P=0.001),
The preventive use of low-dose heparin and low-molecular-weight heparin (LMWH) can significantly reduce the occurrence of venous thromboembolic complications, but this effect has not been seen in non-surgical treatment of tumor patients such as radiotherapy and chemotherapy. Thrombosis in the latter remains the most common. Common complications and the second most common cause of death; prevention measures in this area are not yet widely practiced clinically, and it is now confirmed that LMWH is simple and effective to use and should be listed as the first choice drug. The mechanism of hypercoagulability in cancer patients has now been elucidated: (1) Precancerous coagulation, activation of factor X in the coagulation cascade, (2) aggregation of cell surface prothrombinase complex, conversion of inactive prothrombin to thrombin, (3) expression of cell surface tissue factor (TF), the worse the tumor differentiation, the higher the expression of TF and the hypercoagulability state. The activation of the coagulation system is an important aspect of tumor biology. Within 2 years after the diagnosis of malignant tumors, spontaneous venous thrombosis occurs in 8% of patients. The incidence of thrombosis after tumor surgery is 3 times higher than that of benign disease. The traditional low-dose heparin prevention can reduce this crisis by 80%, but it needs to be injected 2~3 times a day. It is unpopular. LMWH only needs daily Used once, is it Point. In a multicenter group of 3809 operations (40% for cancer), LMWH and standard heparin treatment of fatal pulmonary embolism were 0.7%, but LMWH major bleeding complications was 1.0%, while the standard heparin group It was 1.9% (P=0.02). Also in a group of 2097 cases (63% for cancer) compared to high-dose (5000 U per day) and low-dose LMWH results, the high-dose regimen reduced deep vein thrombosis 12.6% To 6.7% (P=0.001),