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目的探讨低分子肝素在预防高危的深静脉置管的恶性肿瘤患者发生静脉血栓栓塞(VTE)中的效果。方法选择Caprini模型VTE风险度评分≥5分的31例深静脉置管的恶性肿瘤患者为研究对象,在深静脉置管后进行预防性低分子肝素治疗,分析治疗后血栓发生的情况和各项观察指标(年龄、性别、病种等)与血栓发生的关系。结果 (1)预防性低分子肝素治疗后的血栓发生率为9.7%(3/31);(2)31例患者的各项观察指标不同水平的血栓发生率比较,差异均无统计学意义(P>0.05);(3)3例发生血栓的患者均来源于17例(54.8%)有2项或2项以上高危因素(VTE风险度评分、D-二聚体异常、激素治疗)的患者,余14例(45.2%)有0～1项高危因素,但无一例发生血栓,两组血栓发生率比较,差异无统计学意义(P=0.23);(4)低分子肝素预防用药后D-二聚体及血小板计数异常的患者由5例下降至1例。结论低分子肝素预防用药可以在一定程度上减少深静脉置管后高危患者发生VTE,但需进一步开展前瞻性随机对照研究。
Objective To investigate the effect of low molecular weight heparin in the prevention of venous thromboembolism (VTE) in patients with malignant tumors in high-risk deep-vein catheterization. Methods Thirty-one patients with malignant tumor of deep venous catheter in Caprini model with VTE risk score≥5 were selected as the study object. After the catheterization of the deep venous vein, prophylactic low molecular weight heparin was used to treat the thrombosis after treatment. To observe the indicators (age, gender, disease, etc.) and the relationship between thrombosis. Results (1) The incidence of thrombosis after prophylactic low molecular weight heparin treatment was 9.7% (3/31). (2) There was no significant difference in the incidence of thrombosis between different observation indexes of 31 patients P> 0.05). (3) Thrombosis occurred in 3 of the 17 patients (54.8%) with two or more risk factors (VTE risk score, D-dimer abnormality and hormone therapy) , While more than 14 cases (45.2%) had 0-1 high risk factors, but none of them had thrombosis. There was no significant difference in the incidence of thrombosis between the two groups (P = 0.23). (4) After low molecular weight heparin Patients with abnormal dimer and platelet count decreased from 5 to 1. Conclusion Low molecular weight heparin prophylaxis can reduce VTE in high-risk patients after deep vein catheterization to a certain extent, but prospective randomized controlled study is needed.