A randomized controlled study of the efficiency of different preventive methods among patients with moderate and highrisk deep venous thrombosis after gynecological pelvic surgery
ZHOU Qin1,2 LI Xiaojuan2 LIU Chongdong1
1.Department of Obstetrics and Gynecology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China;
2.Department of Gynecology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
Abstract：Objective To explore the preventive effect of different preventive methods among patients with moderate and highrisk deep venous thrombosis (DVT) after gynecological pelvic surgery. Methods From January to August 2019, prospective inclusion of 156 cases with moderate and highrisk DVT patients after gynecological pelvic surgery who admitted Beijing Luhe Hospital, Capital Medical University were selected. According to the random number table method, they were divided into IPC+GCS group (78 cases) and IPC+GCS+LMWH group (78 cases). The incidence of postoperative DVT and pulmonary embolism (PE) and the occurrence of complications were compared between two groups. Results The incidence of DVT in IPC+GCS group was significantly higher than that in IPC+GCS+LMWH group, and the difference was statistically significant (P < 0.05). There was no significant difference in the incidence of PE between two groups (P > 0.05). There was no significant difference in the incidence of DVT in moderate risk patients between two groups (P > 0.05). The incidence of DVT in high-risk patients of IPC+GCS+LMWH group was lower than that of IPC+GCS group, and the difference was statistically significant (P < 0.05). There was no significant difference in PE incidence between two groups of highrisk patients (P > 0.05). The incidence of vaginal stump bleeding in IPC+GCS+LMWH group was significantly higher than that in IPC+GCS group, and the difference was statistically significant (P < 0.05). Conclusion Both IPC+GCS and IPC+GCS+LMWH are safe and effective combined preventive measures for moderate and highrisk patients with DVT after gynecologic pelvic surgery. The combination of IPC+GCS+LMWH is more effective in preventing DVT and PE, especially for high-risk patients.
周勤1,2 李晓娟2 刘崇东1. 不同预防措施对妇科盆腔术后深静脉血栓中高危患者预防效果的随机对照研究[J]. 中国医药导报, 2020, 17(9): 82-86.
ZHOU Qin1,2 LI Xiaojuan2 LIU Chongdong1. A randomized controlled study of the efficiency of different preventive methods among patients with moderate and highrisk deep venous thrombosis after gynecological pelvic surgery. 中国医药导报, 2020, 17(9): 82-86.
[1] 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南（第三版）[J].中华普通外科杂志，2017， 32（9）：807-812.
[2] Kearon C，Akl EA，Comerota AJ，et al. Antithrombotic therapy for VTE disease：Antithrombotic Therapy and Prevention of Thrombosis，9th ed：American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J]. Chest，2012，141（2 Suppl）：e419S-e496S.
[3] 张震宇，郎景和.妇科手术后深静脉血栓形成及肺栓塞——必须重视的手术并发症[J].中华妇产科杂志，2017， 52（10）：654-656.
[4] Li Z，Zhang Z. The incidence and risk factors of venous thromboembolism following elective gynecological surgeries without systemic thromboprophylaxis-an observational cohort study in a Chinese tertiary hospital [J]. Clin Exp Obstet Gynecol，2016，43（3）：365-369.
[5] Freeman AH，Barrie A，Lyon L，et al. Venous thromboembolism following minimally invasive surgery among women with endometrial cancer [J]. Gynecol Oncol，2016，142（2）：267-272.
[6] Barber EL，Clarke-Pearson DL. The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients [J]. Am J Obstet Gynecol，2016，215（4）：445.e1-e9.
[7] Jorgensen EM，Hur HC. Venous Thromboembolism in Minimally Invasive Gynecologic Surgery：A Systematic Review [J]. J Minim Invasive Gynecol，2019，26（2）：186-196.
[8] 杨柏柳，张震宇，郭淑丽.有高危因素的妇科手术患者预防性血栓治疗的临床意义[J].中华妇产科杂志，2009，44（8）：570-573.
[9] Bahl V，Hu HM，Henke PK，et al. A Validation Study of a Retrospective Venous Thromboembolism Risk Scoring Method [J]. Ann Surg，2010，251（2）：344-350.
[10] 《中国血栓性疾病防治指南》专家委员会.中国血栓性疾病防治指南[J].中华医学杂志，2018，98（36）：2861-2888.
[11] 瞿红，张震宇，郎景和.妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志，2017，52（10）：649-653.
[12] Nelson G，Bakkum-Gamez J，Kalogera E，et al. Guidelines for perioperative care in gynecologic/oncology：Enhanced Recovery After Surgery（ERAS）Society recommendations-2019 update [J]. Int J Gynecol Cancer，2019， 29（4）：651-668.
[13] Sang CQ，Zhao N，Zhang J，et al. Different combination strategies for prophylaxis of venous thromboembolism in patients：A prospective multicenter randomized controlled study [J]. Sci Rep，2018，8（1）：8277.
[14] Zhang Z，Lei J，Shao X，et al. Trends in Hospitalization and In-Hospital Mortality From VTE，2007 to 2016，in China [J]. Chest，2019，155（2）：342-353.
[15] Zhai Z，Kan Q，Li W，et al. VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients：The Identification of Chinese Hospitalized Patients′ Risk Profile for Venous Thromboembolism （DissolVE-2）-A Cross-sectional Study [J]. Chest，2019，155（1）：114-122.
[16] Clarke-Pearson DL，Abaid LN. Prevention of venous thromboembolic events after gynecologic surgery [J]. Obstet Gynecol，2012，119（1）：155-167.
[17] Barber EL，Clarke-Pearson DL. Prevention of venous thromboembolism in gynecologic oncology surgery [J]. Gynecol Oncol，2017，144（2）：420-427.
[18] Nelson G，Altman A，Nick A，et al. Guidelines for postoperative care in gynecologic/oncology surgery：Enhanced Recovery After Surgery（ERAS?誖）Society recommendations—Part Ⅱ [J]. Gynecol Oncol，2016，140（2）：323.
[19] Altman AD，Nelson GS. The Canadian gynaecologic oncology perioperative management survey：baseline practice prior to implementation of Enhanced Recovery After Surgery（ERAS）Society Guidelines [J]. J Obstet Gynaecol Can，2016，38（12）：1105-1109.e2.
[20] Linkins LA，Dans AL，Moores LK，et al. Treatment and prevention of heparin-induced thrombocytopenia：Antithrombotic Therapy and Prevention of Thrombosis，9th ed：American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J]. Chest，2012，141（2 Suppl）：e495S-530S.
[21] Haas S，Wolf H，Kakkar AK，et al. Prevention of fatal pulmonary embolism and mortality in surgical patients：a randomized double-blind comparison of LMWH with unfractionated heparin [J]. Thromb Haemos，2005，94（4）：814-819.
2020, Vol. 17 
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