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目的动态监测子宫内膜癌患者外周血D-二聚体及超敏C-反应蛋白(hs-CRP)围手术期前后的变化,从而评价D-二聚体联合hs-CRP检测预警子宫内膜癌术后血栓前状态的价值。方法选取2014年1月-2015年10月该院因子宫内膜癌Ⅰ期合并高血压行子宫内膜癌分期手术的34例患者为研究对象,随机分为观察组和对照组,每组各17例。观察组患者术后6 h即行那屈肝素钙抗凝治疗,对照组患者术后第2天行抗凝治疗。分别于入室开放静脉后(T0)、术毕(T1)、术后6 h(T2)及术后24 h(T3)抽取两组肘静脉血样,检测血红蛋白(Hb)、血细胞比容(HCT)、凝血功能指标、外周血D-二聚体及hs-CRP。采用彩色多普勒超声于术前1 d及术后7 d探测两组患者双下肢深静脉通畅情况。结果与T0比较,T2时两组患者Hb和HCT均明显降低(P<0.05),T3时观察组D-二聚体及hs-CRP均降低(P<0.05),两组患者术后均无皮下瘀斑等出血征象,两组患者术后药物不良反应发生率比较,差异无统计学意义(P>0.05)。术后5 d时对照组出现1例下肢深静脉血栓形成(DVT),DVT发生率为5.88%,观察组无DVT发生。观察组DVT发生率低于对照组(P<0.05)。结论综合D-二聚体及hs-CRP检测水平能预警子宫内膜癌术后血栓前状态,术后早期应用那屈肝素钙,可以降低发生深静脉血栓形成的危险。
Objective To dynamically monitor the perioperative changes of peripheral blood D-dimer and high sensitivity C-reactive protein (hs-CRP) in patients with endometrial carcinoma so as to evaluate the effect of D-dimer combined with hs-CRP in the early detection of endometrial Postoperative value of prethrombotic state. Methods From January 2014 to October 2015, 34 patients with stage Ⅰ endometrial cancer complicated with hypertension undergoing staged surgery for endometrial cancer were selected as study subjects and randomly divided into observation group and control group, each group 17 cases. Patients in the observation group were given nadroparin calcium anticoagulation therapy at 6 hours after operation, and patients in the control group received anticoagulation therapy on the second day after operation. Two groups of elbow venous blood samples were taken at T0, T1, 6 h (T2) and 24 h (T3) after operation, respectively. The levels of hemoglobin (Hb), hematocrit , Coagulation index, peripheral blood D-dimer and hs-CRP. Color Doppler ultrasound in preoperative 1 d and 7 d after the detection of two groups of patients with deep venous patency. Results Compared with T0, Hb and HCT in both groups were significantly decreased at T2 (P <0.05), and both D-dimer and hs-CRP in observation group decreased at T3 (P <0.05) Subcutaneous ecchymosis and other signs of bleeding, two groups of patients after the incidence of adverse drug reactions, the difference was not statistically significant (P> 0.05). One case of deep venous thrombosis of lower extremity (DVT) appeared in the control group on the 5th day after operation, and the incidence of DVT was 5.88%. No DVT occurred in the observation group. The incidence of DVT in observation group was lower than that in control group (P <0.05). Conclusion The combination of D-dimer and hs-CRP can predict the post-thrombotic state of endometrial carcinoma. The application of nadroparin in the early postoperative period may reduce the risk of deep venous thrombosis.