达芬奇心脏手术后体外循环置管血管静脉血栓预防研究

A Study on Venous Thromboprophylaxis of Femoral Vessels after Da Vinci Heart Surgery

摘要: 目的：通过对达芬奇心脏手术后患者分组抗凝治疗，评估抗凝治疗是否具有临床意义，并进一步比较阿司匹林、华法林以及抗血栓压力泵的使用对下肢静脉血栓并发症的预防效果，进而为改善达芬奇心脏手术后患者的血栓并发症提供思路和策略。方法：对达芬奇心脏手术患者术后下肢静脉血栓的预防进行研究，为对比各种治疗方案的效果，将患者分为无抗凝组、物理抗凝组、华法林 + 物理抗凝组、阿司匹林 + 物理抗凝组共4组，进行术后预防性抗凝治疗。收集并记录各组治疗结果，通过统计学分析，评估各组抗凝方案的疗效。结果：在2014年11月至2020年8月，共有311例患者接受了达芬奇心脏手术，其中227例患者纳入术后抗凝研究，包括：无抗凝组97例，物理抗凝组患者34例，华法林 + 物理抗凝组患者65例，阿司匹林 + 物理抗凝组患者31例。无抗凝组出现术后下肢静脉血栓7例(7.2%)，物理抗凝组出现下肢静脉血栓患者3例(8.8%)、腹股沟切口感染患者1列(2.9%)，华法林 + 物理抗凝组无股动静脉血栓患者，但发现腹股沟皮下血肿患者2例(3.1%)、腹股沟切口愈合不良3例(4.6%)，阿司匹林 + 物理抗凝组出现皮下血肿患者1例(3.2%)。结论：达芬奇心脏手术外周体外循环置管后需要常规抗凝治疗，较单纯物理治疗，采取药物加物理预防性治疗，能更有效的预防靶血管血栓形成(P < 0.05)；预防药物方面，采用华法林或阿司匹林的临床效果无明显区别。

Abstract: Objective: To evaluate the clinical significance of anticoagulant therapy by grouping patients after Da Vinci heart surgery. And to evaluate the preventive effect of combined application of aspirin, warfarin and antithrombotic pressure pump on related thrombotic complications, so as to provide new ideas for preventing vascular complications and improving the patient prognosis after da Vinci cardiac surgery. Methods: A study was conducted on the prevention of lower extremities venous thrombosis post da Vinci cardiac surgery. To prevent postoperative femoral vein thrombosis, the patients were divided into four groups: An anticoagulation-free group, a physical anticoagulation group, a warfarin + physical anticoagulation group and an aspirin + physical anticoagulation group. The treatment results of each group were collected and recorded, and the efficacy of anticoagulant regimen in each group was evaluated by statistical analysis. Results: Between November 2014 and August 2020, a total of 311 patients underwent da Vinci cardiac surgery. 227 patients were included in the present study. Of them, there were 97 patients in the anticoagulation-free group, 34 patients in the physical anticoagulation group, 65 patients in the warfarin + physical anticoagulation group and 31 patients in the aspirin + physical anticoagulation group. Seven (7.2%) reported lower extremity venous thrombosis in the anticoagulation-free group. Three (8.8%) reported lower extremity venous thrombosis in the physical anticoagulation group, and one (2.9%) developed inguinal incision infection. No patients developed femoral arteriovenous thrombosis in the warfarin + physical anticoagulation group, but 2 cases (3.1%) occurred inguinal subcutaneous hematoma and 3 case (4.6%) developed inguinal incision infection. There was 1 case (3.2%) with inguinal subcutaneous hematoma in the aspirin + physical anticoagulation group. Conclusions: Anticoagulant therapy is necessary after da Vinci cardiac surgery with extracorporeal circulation catheterization, drugs plus physical prophylactic therapy could prevent target vessel thrombosis more effectively than the application of simple physical therapy (P < 0.05). The preventive drugs indicated no substantial difference in the clinical efficacy of either use of warfarin or aspirin.