| BackgroundAt present,lung cancer is the world's highest incidence of morbidity and mortality.Surgical resection is the most effective method for the treatment of lung cancer.Accelerated rehabilitation after surgery requires effective prevention of postoperative complications,especially pulmonary embolism(PE).Venous thrombus embolism(VTE)includes: deep vein thrombosis(DVT)and pulmonary embolism(PE).Lung cancer patients with vascular endothelial injury caused by surgical trauma and their own blood in a hypercoagulable state are one of the most common malignant tumors with postoperative venous thrombosis.A number of studies have shown that patients who underwent surgery for lung cancer have at least a 2-fold increased risk of developing DVT compared with those who have not undergone surgery,and a three-fold increased risk of PE.Patients who had postoperative lung cancer with VTE had a 2-fold increase in mortality within six months.VTE has become a common cause of postoperative death in patients with lung cancer,seriously affecting the survival and prognosis of patients.In 2012,the Ninth Edition of the American College of Chest Physicians recommended low molecular weight heparin(LMWH)to prevent postoperative VTE.However,due to the special negative pressure environment in the chest,domestic clinicians worry that early prophylactic anticoagulation may increase the risk of postoperative intrathoracic hemorrhage.The initial time of anticoagulation in the early postoperative period is still controversial.ObjectiveTo explore the effects of prophylactic anticoagulant therapy with low molecular weight heparin calcium on postoperative coagulation function and coagulation-related complications in patients with lung cancer at different times.MethodsA prospective study was conducted on 160 patients who underwent surgical treatment of lung cancer from November 2017 to May 2018 in the same surgical team of the Tangdu Hospital.According to the order of the surgical arrangement,SPSS19.0 was randomly divided into 4 groups of 40 people each.Group A,Group B,and Group C were anticoagulation groups,and group D was a blank control group.According to the inclusion exclusion criteria,a total of 118 patients met the criteria for inclusion in the study.Among them,13 cases were excluded in group A,8 cases were benign lesions,4 cases were intraoperative blood transfusion,1 case was drug allergy;8 cases in group B were excluded,6 cases were benign,2 cases were intraoperative blood transfusion;10 cases in group C Exclusion,4 cases of benign lesions,4 cases of intraoperative blood transfusion,2 cases of surgery were removed;11 cases of group D were excluded,8 cases of benign lesions,2 cases of intraoperative blood transfusion,1 case of surgery.All patients were enrolled in the lower extremity pressure ultrasound before and 7 days after surgery.Blood routine,thromboelastography and routine coagulation function were performed before and 1 to 5 days after surgery.Method of administration: Group A patients with lung cancer began 12 hours after surgery,and daily subcutaneous injection of low molecular weight heparin calcium(trade name: Subi Lin)0.4 ml(4100 IU)twice daily for 7 days;group B lung cancer patients At 24 hours after surgery,subcutaneous injection of low molecular weight heparin calcium 0.4 ml twice daily for 7 days;group C lung cancer patients started 48 hours after surgery,subcutaneous injection of low molecular weight heparin calcium 0.4 ml per day,two daily Secondary,continuous application for 7 days;group D lung cancer patients as a blank control group,low-molecular-weight heparin calcium was not used after surgery.Collect relevant data,analyze the changes of coagulation function after anticoagulant therapy at different time points,and the related complications and prognosis of postoperative lung cancer.Results1.There were no significant differences in intraoperative blood loss,operation time,postoperative chest volume,indwelling drainage tube time,and postoperative hospital stay in the 4 groups of lung cancer patients(P>0.05).2.Thrombosis: 0 cases in group A,1 case of calf muscle venous thrombosis(CMVT)in group B,2 cases of CMVT in group C,and 6 cases of CMVT in group D.There was a significant difference between the 4 groups(P=0.04).All patients with lung cancer did not develop clinically symptomatic VTE after surgery.Bleeding-related complications occurred: 2 patients with wound oozing in group A,1 patient with hemoptysis in group B,1 patient with hematuria in group C,and no patients with bleeding in group D.There was no significant difference between the 4 groups(P=0.535)..3.TEG can detect 4 groups of patients all of the lung cancer patients in the first day after surgery in hypercoagulable state,the earlier application of low molecular weight heparin calcium anticoagulation,R value returned to normal sooner.Conventional coagulation tests do not reflect changes in coagulation function between the anticoagulation group and the blank group.The effects of anticoagulants on red blood cells,hemoglobin,and platelets were not significantly different from those in the blank group.Conclusion1.The blood of patients with lung cancer is hypercoagulable,and it is easy to form venous thrombosis of lower extremities.The lower extremity intermuscular venous thrombosis is the most easily formed.2.Low-molecular-weight heparin calcium should be used 12 hours after surgery,which can significantly improve postoperative hypercoagulability and reduce the risk of thrombosis,and will not increase postoperative chest volume and bleeding complications.3.As a new tool for monitoring blood coagulation status,thromboelastography is superior to conventional coagulation series in the evaluation of postoperative thrombosis risk in lung cancer.4.Platelet,hemoglobin and red blood cells decreased progressively after lung cancer,reached the lowest point on the 4th day after surgery,and then began to rise slowly,which was less affected by anticoagulant therapy. |
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