| 颅脑创伤后静脉血栓栓塞症的研究进展 |
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| 引用本文： | 余鹏,吴思荣.颅脑创伤后静脉血栓栓塞症的研究进展[J].中华全科医学,2020,18(12):2082-2085. |
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| 作者姓名： | 余鹏 吴思荣 |
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| 作者单位： | 苏州大学附属第一医院急诊医学科, 江苏 苏州 215006 |
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| 摘 要： | 静脉血栓栓塞症(venous thromboembolism,VTE)包括深静脉血栓形成(deep venous thrombosis,DVT)和肺栓塞(pulmonary embolism,PE),是导致住院患者非预期死亡和残疾的重要原因。颅脑创伤(traumatic brain injury,TBI)患者因受意识障碍、手术、深静脉置管、脱水治疗、全身性感染、长期卧床以及肢体功能障碍等诸多因素的影响,是发生VTE的高危人群,但VTE是可以预防的。目前TBI患者VTE的预防措施包括基础预防、物理预防、药物预防和下腔静脉滤器植入预防等。由于不会增加出血的风险,VTE的物理预防措施使用范围更加广泛和安全,已成为标准化预防血栓的重要组成部分。抗凝治疗作为预防VTE的基础治疗是相对安全且有效的。但针对TBI患者,由于担心抗凝药物会导致新的出血过程或最初出现的颅内出血(intracranial hemorrhage,ICH)进展,大多数创伤外科医生更倾向于延迟TBI患者的VTE药物预防。正确评估患者VTE风险并及时给予有效的抗栓治疗,力求“抗栓获益/出血风险”最大化,是临床医师所面临的重大课题。本文对TBI后VTE的发病率、危险因素、诊断及防治等相关研究进展进行综述。
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| 关 键 词： | 颅脑创伤 静脉血栓栓塞症 深静脉血栓形成 肺栓塞 |
| 收稿时间： | 2020-03-25 |
Research progress of venous thromboembolism in patients after traumatic brain injury |
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| Affiliation: | Department of Emergency, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China |
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| Abstract: | Venous thromboembolism(VTE), including deep venous thrombosis(DVT) and pulmonary thromboembolism(PE), is an important cause of unexpected death and disability of inpatients. Traumatic brain injury(TBI) patients are at high risk of VTE because of many factors such as consciousness disorder, operation, deep vein catheterization, dehydration treatment, systemic infection, long-term bed rest and limb dysfunction, but VTE can be prevented. The current preventive measures for VTE in TBI patients include basic prevention, physical prevention, drug prevention, and prevention of inferior vena cava filter implantation. Because it does not increase the risk of bleeding, the physical prevention measures of VTE are more widely used and safe, and have become an important part of standardized prevention of thrombosis. Anticoagulation therapy is relatively safe and effective as a basic treatment to prevent VTE. However, for patients with TBI, most neurosurgeons are more inclined to delay VTE drug prevention in patients with TBI due to concerns that anticoagulant drugs will lead to a new bleeding process or the initial development of intracranial hemorrhage(ICH). It is a major issue for clinicians to correctly assess the VTE risk of patients and give effective antithrombotic treatment in a timely manner to maximize the benefits of antithrombotic/bleeding risk. This article reviews the incidence, risk factors, diagnosis and prevention of VTE after TBI. |
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