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目的:采用前瞻性随机对照的方法比较分级预防措施对钬激光前列腺剜除术(holmium laser enucleation of the prostate,HoLEP)后预防早期深静脉血栓(deep vein thrombosis,DVT)的作用。方法:纳入2014年3月~2016年1月收治的712例BPH患者,按风险因子评估分成中低危组206例(28.9%)、高危组370例(52.0%)和极高危组136例(19.1%),后两组再随机各分为对照组和试验组,即高危A组和高危B组、极高危C组和极高危D组。在术后给予不同的血栓预防措施,利用超声对手术前后DVT情况进行评估。结果:高危A组发生DVT者10例,发生率为5.41%(10/185);高危B组发生DVT者4例,发生率为2.16%(4/185),两组之间比较,差异无统计学意义(χ2=2.67,P=0.102)。极高危C组发生DVT者8例,发生率为11.76%(8/68);极高危D组发生DVT者2例,发生率为2.94%(2/68),两组之间比较,差异有统计学意义(χ2=3.89,P=0.049)。结论:采取分级预防措施可安全有效地预防早期DVT的发生。基础和物理预防措施联合应用低分子肝素(LMWH)抗凝治疗,对极高危患者具有重要意义。
Objective: To compare the effects of grading prophylaxis on the prevention of early deep vein thrombosis (DVT) after holmium laser enucleation of the prostate (HoLEP) by a prospective randomized controlled trial. Methods: A total of 712 BPH patients admitted to our hospital from March 2014 to January 2016 were divided into two groups according to the risk factors: 206 cases (28.9%) in the low-risk group, 370 cases (52.0%) in the high-risk group and 136 cases 19.1%). The latter two groups were randomly divided into control group and experimental group, namely high-risk group A and high-risk group B, very high-risk group C and very high-risk group D. Different postoperative thromboprophylaxis was given and the use of ultrasound to assess the presence of DVT before and after surgery. Results: In high-risk group A, DVT occurred in 10 cases (5.41%, 10/185). In high-risk group B, DVT occurred in 4 cases (2.16%, 4/185). There was no significant difference between the two groups Statistical significance (χ2 = 2.67, P = 0.102). In the very high risk group, 8 cases of DVT occurred in C group, the incidence rate was 11.76% (8/68); in the very high risk group, 2 cases occurred DVT in D group, the incidence was 2.94% (2/68) Statistical significance (χ2 = 3.89, P = 0.049). Conclusion: It is safe and effective to prevent the occurrence of early DVT by taking preventive measures. Basic and physical precaution combined with low molecular weight heparin (LMWH) anticoagulant therapy is of great importance to very high-risk patients.