下肢静脉曲张手术后深静脉血栓形成的原因及预防

摘要

Objective To explore the causes and preventive strategies of deep venous thrombosis (DVT)after varicose vein surgery(VVS). Methods The clinical data of 1187 patients undergoing VVS were retrospectively analyzed. Among them,425 patients received subcutaneous injection of low molecular weight heparin(LMWH)from 2010. 10 to 2011. 08( LMWH group)and the other 762 patients were not given subcutaneous LMWH from 2009. 01 through 2010. 09 ( non-LMWH group). Results There were no significant differences in subcutaneous petechiae, wound with blood stasis, leg swelling and/or calf pain between the two groups. Some risk factors related to DVT and the procedures associated with VVS may induce DVT. DVT was detected in 8 out of 762 patients in non-LMWH group, and in only one patient in LMWH group; There was significantly difference between them. Platelet count,prothrombin time,thrombin time,fi-brinogen and activated partial thromboplastin time were not significantly changed by subcutaneous injection of LMWH for 5 days after VVS. Conclusion Interaction of multi-factors may induce DVT after VVS. The prophylactic administration of LMWH is effective and safe in preventing DVT after VVS.%目的 探讨下肢静脉曲张手术(varicose vein surgery,VVS)后下肢深静脉血栓形成(deep venous thrombosis,DVT)的原因及预防.方法 回顾性分析1187例VVS患者的临床资料,其中,2010年10月至2011年8月期间425例VVS患者术后预防性应用低分子肝素(LMWH组),2009年1月至2010年9月期间762例VVS患者未用低分子肝素(非LMWH组).结果 皮下瘀斑,创口瘀血,下肢肿胀和/或疼痛在两组间的发生率差异无统计学意义；与血栓形成相关的危险因素可以诱发DVT；非LMWH组发生DVT 8例,LMWH组发生DVT 1例,两组比较差异有统计学意义(P＜0.05)；在LMWH组,LMWH应用5d后的有关凝血功能指标与术前相比无明显变化.结论 VVS后多种因素相互作用诱发DVT；预防性应用低分子肝素能有效降低VVS后DVT,且临床应用是相对安全的.