摘要
目的探讨早期应用阿司匹林联合低分子肝素钙预防断流术后门静脉血栓（PVT）形成的疗效。方法将90例肝硬化门静脉高压症患者分成两组（对照组44例，观察组46例），均行脾切除＋贲门周围血管离断术，自术后当天开始观察，发现腹腔和胃肠引流液中不含血性液时，观察组开始皮下注射低分子肝素钙4100IU／d，10d。两组均于PLT〉300×10^9／L时开始静脉滴注低分子右旋糖酐500ml／d，7～14d；口服肠溶阿司匹林100mg／d，直至PLT恢复正常。术后每周行腹部超声检查1次，连续3周以评价PVT形成情况。结果观察组在断流术后PVT发生率（7％）明显低于对照组（27％）（χ2=6．972，P〈0．05）；观察组术后并发症发生率（7％）明显低于对照组（32％）（χ2=9．393，P〈0．01）；观察组术后病死率（2％）明显低于对照组（18％）（χ2=4．748，P〈0．05）；观察组住院时间（18±7）d明显少于对照组（31±12）d（t=6．311，P〈0．01）；两组外周血PLT计数自术后第1天开始至术后60d相比差异无统计学意义（P〉0．05）；两组术后2周内凝血酶原时间相比差异无统计学意义（P〉0．05）；两组术后2周内部分凝血酶原时间相比差异无统计学意义（P〉0．05）；因使用抗凝药物引发皮下出血等不良反应：对照组0例，观察组2例（χ2=0．558，P〉0．05）。结论早期应用阿司匹林联合低分子肝素钙预防断流术后PVT形成是一种安全有效的方法。
Objective To evaluate the effect of early aspirin combined with low molecular weight heparin calcium in prevention of portal system thrombosis after portaazygous disconnection in patients of portal hypertension. Methods In this study, 90 cases with cirrhotic portal hypertension were divided randomly into two groups （control group ：44 cases, observation group ：46 cases） , after standard splenectomy and pericardial devascularization. On the day when abdominal and gastrointestinal drain was not bloody （at 2-5 d, mean 3 d after operation）,low molecular weight heparin calcium 4100 IU per day was given to observation group by subcutaneous injection for 10 days. During treatment, blood platelet （PLT） count was monitored. When PLT in both groups 〉 300 × 10^9/L, low molecular dextran 500 ml per day was given by iv drip for 7 - 14 days, oral enteric aspirin 100 mg/day was given, until PLT reached normal range. Portal venous thrombosis was evaluated by color Doppler ultrasonography weekly for 3 weeks. Results Postoperative incidence of portal vein thrombosis in observation group（7% ） was lower significantly than that in control group （ 27% ） （ χ2= 6. 972, P 〈 0. 05 ）. Incidence of postoperative complications in observation group （7%） were lower significantly than that in control group（32% ） （χ2=9. 393 ,P 〈0. 01 ）. Mortality rate in observation group（2% ） were lower significantly than that of control group（ 18% ） （χ2 = 4. 748,P 〈 0. 05 ）. There was no significant difference between the two groups in blood platelet count during observation （ P 〉 0. 05 ）. Prothrombin time, active pact thromboplastin time were also similar in the two groups （P 〉 0. 05 ）. Side effect such as self-limited subcutaneous hemorrhage developed in no cases in control group compared to two cases in observation group （χ2= 0. 558 ,P 〉 0. 05 ）. Conclusion It is a safe and effective method to use early aspirin combined with low molecular weight heparin in the prevention of portal system thrombosis after splenectomy and portaazygous devascularization in cirrhotic portal hypertensive patients.
出处
《中华普通外科杂志》
CSCD
北大核心
2010年第4期299-302,共4页
Chinese Journal of General Surgery
