Effects of different intervention time of anticoagulant on surgical patients with lung cancer
不同干预时间下抗凝药物对肺癌手术患者的影响

摘要

目的 探讨不同时间预防性应用低分子肝素抗凝对肺癌手术患者的影响。方法 收集2024年8月-2025年8月在西安交通大学第一附属医院进行手术治疗的180位肺癌患者，根据其抗凝药物使用情况分为术前抗凝组43例、术后抗凝组79例、未抗凝组58例。对比三组手术时间、术中出血量、术后引流管留置时间、术后总引流量、术后住院时间等术中及术后临床指标、术后血栓性疾病的发生情况，并分别于术前及术后第1、2、3、4、5天应用血栓弹力仪对患者进行血栓弹力图检查。结果 三组患者手术时间、术中出血量、术后引流管留置时间、术后总引流量、术后住院时间等术中及术后临床指标无统计学差异（P＞0.05）；术后第1、2、3、4、5天，术前抗凝组、术后抗凝组与未抗凝组R值具有统计学差异（P＜0.05），其余各指标均无统计学差异（P＞0.05），术前抗凝组与术后抗凝组各指标差异无统计学意义（P＞0.05）；术前抗凝组、术后抗凝组术后血栓性疾病发生率明显低于未抗凝组（P＜0.05），术前抗凝组与术后抗凝组术后血栓性疾病发生率差异无统计学意义（P＞0.05），三组术后出血发生率差异无显著性（P＞0.05）。结论 应用低分子肝素预防性抗凝治疗可降低肺癌手术患者术后静脉血栓形成的风险，术前或术后用药临床效果相当。

Abstract

Objective To explore the effects of prophylactic anticoagulation with low molecular weight heparin (LMWH) and starting administration at different times on patients with lung cancer surgery.
Methods 180 lung cancer patients who underwent surgical treatment in our hospital from August 2024 to August 2025 were selected and divided into the preoperative anticoagulant group (n=43), the postoperative anticoagulant group (n=79) and the non-anticoagulant group (n=58) according the use of anticoagulant drugs. The intraoperative and postoperative clinical indicators including operative time, intraoperative bleeding, postoperative drainage tube indwelling time, postoperative chest volume and postoperative hospital stay and the incidence of thrombotic disease after surgery were compared among the three groups. Thromboelastogram was examined before surgery and on the 1st, 2nd, 3rd, 4th and 5th day after surgery.
Results There was no significant difference in operative time, intraoperative bleeding, postoperative drainage tube indwelling time, postoperative chest volume and postoperative hospital stay among the three groups (P＞0.05). On the 1st, 2nd, 3rd, 4th and 5th day after operation, there was significant difference in R value among preoperative anticoagulation group, postoperative anticoagulation group and non-anticoagulation group. There was no significant difference between the other indicators(P＞0.05). The incidence of postoperative thrombotic diseases in the preoperative and postoperative anticoagulant group was lower than that in the non-anticoagulant group (P＜0.05). There was no significant difference in the incidence of postoperative thrombotic diseases between preoperative anticoagulant group and postoperative anticoagulant group(P＞0.05). There was no significant difference of the incidence of postoperative bleeding among the three groups (P＞0.05).
Conclusion   The use of low-molecular-weight heparin prophylactic anticoagulation therapy can reduce the risk of postoperative venous thrombosis in patients with lung cancer. The clinical value of preoperative or postoperative prophylactic anticoagulation is equivalent.