李卿 王丽林

[摘要] 目的 探討低分子肝素钠抗凝在肝硬化合并门静脉血栓中的应用效果，并评估对患者医疗费用的影响。 方法 选择2015年1月～2016年4月在衡水市第四人民医院住院的肝硬化合并门静脉血栓患者200例，按照随机数字表法分为观察组和对照组，每组各100例。对照组给予常规治疗，观察组在对照组基础上给予低分子肝素钠抗凝0.4 mL/次，1次/d，连续6个月。比较两组患者凝血状况、门静脉血栓体积、不良反应、住院时间及住院费用等指标。 结果 治疗后2周及治疗后1、2、4、6个月，观察组门静脉血栓平均体积均低于对照组，差异均有统计学意义（P < 0.05）；两组凝血酶原时间和血小板计数比较，差异无统计学意义（P > 0.05）。观察组门静脉血栓再通率高于对照组，差异有统计学意义（P < 0.05）。观察组并发症发生率、住院时间和住院费用均低于对照组，差异均有统计学意义（均P < 0.05）。 结论 应用低分子肝素钠抗凝治疗肝硬化合并门静脉血栓，能够显著降低门静脉血栓体积、提高再通率，减少远期并发症和住院时间，降低医疗费用。

[关键词] 肝硬化；门静脉血栓；低分子肝素钠；抗凝效果

[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-7210（2018）02（a）-0069-04

Effects of low molecular weight heparin anticoagulation in cirrhotic patients with portal vein thrombosis

LI Qing WANG Lilin

Department of Gastroenterology， Hengshui Fourth Hospital， Hebei Province， Hengshui 053000， China

[Abstract] Objective To explore the effects of low molecular weight heparin anticoagulation in cirrhotic patients with portal vein thrombosis and to assess the impact on patients′ medical costs. Methods From January 2015 to April 2016， 200 cases of cirrhosis patients with portal vein thrombosis in Hengshui Fourth Hospital were selected and divided into the observation group and the control group according to the random number table， with 100 cases in each group. The control group was given routine treatment and the observation group was given low molecular weight heparin sodium anticoagulant 0.4 mL， 1 time a day for six months. The coagulation status， portal vein thrombosis， adverse reactions， hospitalization time and the hospital costs were compared between the two groups. Results After 2 weeks， 1， 2， 4 month and 6 month， the average volume of portal vein thrombosis in the observation group were all lower than those of control group， with statistically significant differences （P < 0.05）； there were no significant differences in prothrombin time and platelet count between the two groups （P > 0.05）. The recanalization rate of portal vein in the observation group was higher than that of control group， with statistically significant difference （P < 0.05）. The incidence of complications， hospitalization time and hospitalization cost in the observation group were all lower than that of control group， with statistically significant differences （P < 0.05）. Conclusion The application of low molecular weight heparin sodium anticoagulation in the treatment of cirrhosis with portal vein thrombosis can significantly reduce the volume of portal vein thrombosis， improve the recanalization rate， reduce the long-term complications， shorten the hospitalization time and reduce the medical costs.

[Key words] Cirrhosis； Portal vein thrombosis； Low molecular weight heparin； Anticoagulant effect

门静脉血栓是一种深部的血管阻塞性疾病，其中肝硬化是导致门静脉高压症的主要病因之一，门静脉血栓阻碍门静脉回流，加重门脉高压，增加了门脉高压性出血的风险，是影响肝硬化预后恶化的因素[1-3]。临床治疗门静脉血栓以溶栓、手术及介入等为主，其中抗凝治疗被认为是安全且有效的方式。低分子肝素是一种应用广泛的抗凝药物，主要应用在心、脑血管疾病及弥漫性血管内凝血等疾病的治疗[4-5]，目前国内应用低分子肝素钠治疗肝硬化合并门静脉血栓的研究较少，本研究旨在针对肝硬化合并门静脉血栓患者，应用低分子肝素钠抗凝进行治疗，探讨其抗凝效果，并评估其对医疗费用的影响。……