老年骨科手术患者下肢深静脉血栓的预防与治疗

下肢深静脉血栓形成(deep venous thrombosis,DVT)是骨科患者的常见并发症[1],尤其是在老年骨科手术后多见,严重时会并发肺栓塞,成为老年骨科手术患者致残或致死的突出原因.Colwell报道在没有任何预防措施的情况下骨科手术后DVT的发生率为40%～60%[2].因而如何有效防治下肢DVT成为医学界的热点问题.综合文献报道,有临床表现的DVT发生率分别为:髋关节置换术3%,膝关节置换术10%,髋部骨折2%;约2%髋关节置换术者,于术后10 d以上出现DVT的症状和体征,而膝关节置换术者DVT多发生于术后早期.因此,本文旨在探讨老年骨科手术患者DVT的预防与治疗.     

创伤骨科下肢骨折手术围手术期深静脉血栓形成的预防与护理

目的 分析对于创伤骨科下肢骨折手术患者在围手术期内的有效护理措施以及在预防深静脉血栓形成中的应用价值.方法 对照组在围手术期内进行常规护理,同期观察组在该基础上开展针对性护理.结果 观察组手术后下肢深静脉血栓形成、肢体疼痛以及肿胀等发生率均低于对照组(P<0.05).结论 针对创伤骨科的下肢骨折手术患者在围手术期内开展针对性护理,可有效预防下肢深静脉血栓形成,并降低疼痛和肿胀等并发症率.     

骨科围手术期深静脉血栓形成的护理体会

2008年8月～2010年2月，我院收治28例骨科术后发生下肢深静脉血栓患者。 现将护理体会报告如下。临床资料：本组28例患者，男18例、女10例，年龄31～83岁；患病肢体：左下肢21例，右下肢6例，双下肢1例；急诊手术治疗8例，择期手术治疗20例。患者均行抗感染、促进血液循环、防止血小板聚集等对症支持治疗，其中2例行下腔静脉滤器植入术、1例行取栓术，     

低分子肝素钙预防中老年骨科手术后深静脉血栓形成和肺栓塞

手术是形成下肢深静脉血栓形成(LDVT)的一个主要因素〔1〕,而80%～90%肺栓塞(PE)栓子来源于LDVT〔2〕。骨科手术,尤其人工髋关节置换术、人工膝关节置换术、髋部周围骨折手术及脊柱手术等大手术更易发生深静脉血栓形成(DVT),少数可造成PE导致死亡。1资料与方法1.1一般资料选择1998年1月至2008年12月我院骨科收治的40岁以上中老年人行脊柱手术、髋关节置换手术、膝关节置换手术、髋部骨折手术的患者,并分观察组和对照组,其中对     

骨科手术后深静脉血栓形成的预防及护理

下肢深静脉血栓形成（DVT）是骨科手术后常见的并发症之一,可导致患肢终生粗肿,影响生活质量,严重者可发生致命性肺栓塞。2008年5月~2013年12月,我院收治骨科手术后下肢DVT患者56例。现就其预防和护理体会报告如下。临床资料：本文56例,男39例、女17例,年龄25~68岁。     

骨科住院患者下肢深静脉血栓形成危险因素分析及预防对策

目的:研究骨科住院患者深静脉血栓(DVT)形成的发病情况分析相关危险因素,根据患者不同情况采取相应预防措施,观察临床效果。方法:将所有2002年12月至2006年8月骨科住院术后或须卧床7d以上患者随机分为治疗组和对照组,其中治疗组430例,围手术期或卧床期间使用低分子肝素0.4mL每12h皮下注射1次。对照组412例,无任何预防措施,2组均于绝对卧床或术后7d行双下肢血管超声检查。结果:治疗组DVT总发生率8.7%,其中髋关节置换术后发生率21.8%,合并下肢严重软组织挫伤发生率19.3%,股、腘静脉血栓发生率5.3%,对照组DVT总发生率22.7%,其中髋关节置换术后发生率48.3%,合并下肢严重软组织挫伤发生率39.8%,股、腘静脉血栓发生率7.8%。2组比较差异有显著性(P<0.05)。所有患者症状性DVT发生率11.2%,症状性肺栓塞11例,死亡2例。治疗组未发现明显出血增多等不良反应。结论:对骨科住院患者进行危险因素评估,采取恰当的预防措施,可降低患者下肢DVT的发生率,提高治疗效果。     

空气波压力治疗仪与低分子肝素联合应用对老年下肢深静脉血栓患者的疗效

下肢深静脉血栓(DVT)症状主要是下肢水肿、继发性静脉曲张、皮炎、色素沉着、郁滞性溃疡等.临床表现通常表现为单侧肢体的突然肿胀.下肢DVT患者局部感觉疼痛,行走时加剧.本文拟观察空气波压力治疗仪(IPC)与低分子肝素(LM-WH)联合应用对下肢DVT老年患者的疗效.     

组织因子途径抑制物-1与深静脉血栓形成的研究进展

深静脉血栓 (DVT) 指深静脉管腔内血液的异常凝结,常见于创伤或手术后患者,好发于下肢,若不及时发现并对其进行有效治疗,早期可因血栓栓塞局部深静脉管腔导致疼痛性股青肿,或血栓脱落继发致命性肺栓塞;晚期遗留深静脉瓣功能不全,成为严重危害患者健康的疾病之一.血液中存在一套相互拮抗的凝血和抗凝血系统,在正常情况下,通过复杂而精细的调节保持动态平衡,既维持血液在血管内呈液体流动状态,又在一旦出现血管破裂的情况下迅速在局部凝固形成止血栓,防止出血.若凝血和抗凝血过程中出现调节障碍或凝血系统在心血管内被不适当激活,从而造成血栓形成.     

老年人工髋关节置换术后深静脉血栓的防治体会

2000年6月～2007年6月，我院行老年人工髋关节置换（THA）手术206例，其中发生深静脉血栓（DVT）16例，发生率7．7％。现就DVT防治措施分析如下。     

妇产科手术后并发下肢深静脉血栓的防治及护理

目的：探讨妇产科手术患者术后出现下肢深静脉血栓（ DVT）并发症的有效防治和护理措施。方法选取90例妇产科手术患者为观察对象并将其随机分成实验组和对照组,两组各45例。对照组患者接受常规护理,实验组患者则接受DVT防治性护理方案,比较两组DVT的发生情况。结果经护理后两组患者均痊愈出院,其中实验组发生DVT 1例（2.2％）,对照组中发生DVT 11例（24.4％）,两组比较差异有统计学意义（ P＜0.05）。结论合理的护理方案对DVT发生率有显著的控制效果,临床应针对妇产科手术患者制定科学、合理的DVT防治性护理方案,从而降低其发生率。     

Current controversies in deep vein thrombosis prophylaxis after orthopaedic surgery

As a result of easy measurable perioperative bleeding and a high number of subclinical deep vein thromboses after surgery, total hip replacement has become a benchmark for antithrombotic drug development. Today, a nonscientific evidence-based transatlantic view on thromboprophylaxis in orthopaedic surgery exists. Efforts should be taken to bridge these divergent opinions. We need to standardize study designs that allow unbiased comparison and aggregation of data to get insight in rare complications like the cauda equina syndrome associated with spinal analgesic techniques and anticoagulation and to optimize thromboprophylaxis in homogeneous groups of patients. Dosage, timing of initiation in relation to surgery, and duration of prophylaxis seems a crucial and open question for all homogeneous groups of orthopaedic patients. A definition on surgical bleeding, which allows practical measurement procedures and quantification, is lacking. Clinical studies on vascular endpoints are warranted to achieve relevant basic data for health economic analyses, which also lack scientific standardized procedures. An intercontinental close cooperation is needed to solve these issues.     

Effect of ulinastatin combined rivaroxaban on deep vein thrombosis in major orthopedic surgery

Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups:ulinastatin continuous infusion(Uc) group,ulinastatin single injection(Us) group and control(C) group.All patients received patient-controlled intravenous analgesia(PCIA) after operation,and took Rivaroxaban 10 mg orally 12 hours after operation.Ulinastatin(5 000 U/kg)was given intravenously to both Uc and Us groups preoperatively.Group C was given isometric normal saline,group Uc was pumped UTI continuous intravenously at the end of surgery(10 000U/kg) to 48 hours through PCIA pump.The values of hematocrit(HCT),thrombomodulin(TM),Interleukin(IL-6),thrombin-antithrombin complex(TAT),D-Dimer(D-D) were normally tested before surgery(T1),at the end of the surgery(T2),12 hours(T3).24 hours(T4) and 48 hours(T5)after surgery.Results:Compared with T1,there was an upward tendency in TM,IL-6,TAT,and D-D after operation in group C group(P 0.05).The values of them were significandy increased from nearly 24-hour after surgery in Us group(P0.05).In group Uc.there were no significant changes in these indices after operation(P0.05).Conclusions:During the perioperative period,ulinastatin continuous infusion combined Rivaroxaban can correct blood hypercoagulability through different approaches in patients undergoing major orthopedic surgery.     

Treatment of deep vein thrombosis with low molecular weight heparins at home

Treatment of patients with proximal vein thrombosis with low molecular weight heparins is effective and safe. So it allows "hospital at home" care. Among low molecular weight heparins tinzaparin is given once daily, making the compliance easier. The twenty patients with deep vein thrombosis who were assisted in the "hospital at home" unit of the Clínica Nuestra Se?ora de la Concepción in Madrid from December 1999 to December 2000. The mean of age was 71 + 15. The most frequent risk factors were surgery in past three months (19%), known tumour (15%) and previous venous thrombosis (15%). Eighteen patients were treated with tinzaparin. No patients showed adverse effects nor complications. Low molecular weight heparins, specially tinzaparin, are a safe and effective treatment for deep vein thrombosis in our unit.     

Evaluation of relationship between KEAP1 gene and genetic susceptibility of deep vein thrombosis after orthopedic surgery in Han Chinese population

Journal of Thrombosis and Thrombolysis - Deep vein thrombosis (DVT) is the blood clot formed in a vein deep in body, mostly occurred in the lower leg or thigh. Early studies indicate that DVT is a...     

Comparison of four strategies for diagnosing deep vein thrombosis: a cost-effectiveness analysis

PURPOSE: Four strategies for the diagnosis of deep vein thrombosis have been validated recently. The strategies use various combinations of assessment of a patient's clinical probability of having deep venous thrombosis, serial lower limb venous compression ultrasonography, and measurement of plasma D-dimer levels. We compared the cost-effectiveness of these diagnostic strategies. MATERIALS AND METHODS: We performed a formal cost-effectiveness analysis using a decision-analysis model. Outcomes considered were costs per patient, 3-month quality-adjusted survival, number of lives saved per 1,000 patients, and incremental costs per quality-adjusted life-year (QALY) gained. RESULTS: Under baseline conditions, with a 24% prevalence of deep vein thrombosis in tested patients, the effectiveness of all strategies was similar (4.6 to 4.8 lives saved per 1,000 patients managed). The most expensive strategy was serial ultrasound (repeat ultrasound on day 7 in all patients with a normal initial ultrasound) at a cost-effectiveness of $10,716 per additional QALY. Performing a repeat ultrasound only in patients with an elevated D-dimer level (serial ultrasound with D-dimer) was somewhat less expensive at $10,281 per additional QALY. Taking clinical probability into account by repeating ultrasound only in patients with an intermediate clinical probability of deep vein thrombosis (risk-based serial ultrasound) yielded further savings and cost $10,090 per additional QALY. The least expensive and most cost-effective option was to perform D-dimer as the initial test, followed by a single ultrasound if the D-dimer level was abnormal, and by phlebography in patients with a normal ultrasound and a high clinical probability of deep vein thrombosis (D-dimer with risk-based single ultrasound) at $8,897 per additional QALY. This strategy allowed a 17% reduction in incremental costs compared with the most expensive algorithm and reduced resource consumption (70 ultrasound procedures per 100 patients managed vs 130 to 170 with the other diagnostic strategies). CONCLUSIONS: Combining clinical probability and D-dimer with a single ultrasound in the diagnostic workup of patients with possible deep vein thrombosis is highly cost-effective, allowing a reduction in costs and resource use without any substantial increase in mortality. Serial ultrasonography is less cost-effective.     

妇科盆腔阴式手术后并发下肢深静脉血栓40例诊治探讨

目的：探讨妇科盆腔阴式手术后并发下肢深静脉血栓（ LEDVT）的临床治疗效果。方法回顾性分析40例妇科盆腔阴式手术并发LEDVT患者的临床表现特点、诊断及治疗方法。结果妇科盆腔阴式手术后LEDVT的发生率为1％（40／4000）,采用复方丹参注射液、低分子肝素钙注射液及低分子右旋糖肝注射液,或者加用活血化瘀中药、路路通及阿司匹林等药物治疗后,40例LEDVT均治愈。随访3个月～2年,所有患者均无后遗症出现。结论对妇科盆腔阴式手术后的LEDVT患者,应做到早诊断、早治疗,可获得满意的疗效。     

Relation between peri-operative antithrombin activity and deep vein thrombosis after elective hip replacement surgery

BACKGROUND: The purpose of the study was to evaluate whether the postoperative depletion or the preoperative antithrombin (AT) activity is related to the occurrence of deep vein thrombosis (DVT) in patients receiving low-molecular-weight heparin for DVT prevention after elective hip replacement surgery. PATIENTS AND METHODS: In 93 patients AT-activity and standard laboratory parameter were determined on the preoperative day and daily for one week after operation. Furthermore, a color-coded compression sonography was performed before and 8-10 days after surgery. The amount of blood loss and blood transfusions was evaluated. Patients were divided into two groups in respect to the occurrence of a postoperative DVT. RESULTS: The overall incidence of DVT was 8.6% (n = 8). Patients with DVT had a significantly lower preoperative AT-activity (80.6 +/- 3.31%) compared to those without DVT (98.1 +/- 1.12%, p < 0.001), however, without being predictive for DVT (positive predictive value 0.71). There was no association between postoperative fall of AT, the lowest postoperative AT activity, blood loss or blood substitution and DVT. CONCLUSIONS: It has to be expected that a small fraction of patients for elective hip surgery present with AT-activity levels possibly being insufficient for a therapeutic effect of low-molecular-weight heparin even preoperatively. Those patients are subject to a significant higher risk of DVT postoperatively.