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目的 探讨腹腔镜直肠癌手术患者术中不同模式间歇充气加压装置(intermittent pneumatic compression,IPC)预防下肢深静脉血栓(deep vein thrombosis,DVT)的效果。方法 2020年4月—2021年4月,在温州市某三级甲等医院结直肠外科连续选择符合纳入标准的130例拟行腹腔镜直肠癌根治术患者作为研究对象。采用随机数字表法分为对照组、试验组Ⅰ、试验组Ⅱ、试验组Ⅲ。对照组围手术期采用常规护理方法预防下肢DVT。各试验组在对照组基础上,手术全程采用对应的IPC模式预防下肢DVT。试验组Ⅰ采用IPC双足模式,足底气囊加压130 mmHg(1 mmHg=0.133 kPa),持续6 s,放松12 s。试验组Ⅱ采用IPC双小腿模式,气囊于小腿序贯加压80 mmHg,持续12 s,放松24 s。试验组Ⅲ采用IPC双小腿+大腿模式,气囊分别从足踝、小腿、大腿部位序贯加压80、70、60 mmHg,持续24 s,放松24 s。比较4组麻醉诱导前和拔管后双下肢静脉血流动力学变化及术后血栓发生率。结果 与对照组相比,试验组Ⅰ和试验组Ⅱ:麻醉诱导前和拔管后,双侧股总静脉、股浅静脉、腘静脉的血流速度变化率差异有统计学意义(P<0.05),管径变化率差异无统计学意义(P>0.05)。术后第1天下肢DVT发生率明显下降,差异有统计学意义(P=0.039,P=0.042)。与对照组相比,试验组Ⅲ:麻醉诱导前和拔管后,双侧股总静脉血流速度变化率差异无统计学意义(P>0.05),各静脉管径变化率差异均无统计学意义(P>0.05)。术后第1天下肢DVT发生率无改善,差异无统计学意义(P=0.820)。4组术后第7天血栓发生率差异均无统计学意义(P=0.125)。结论 术中IPC足模式和IPC小腿模式均能改善下肢血流动力学,预防腹腔镜直肠癌患者术后第1天血栓发生,且效果相近。  相似文献   
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目的总结骨科围手术期患者静脉血栓栓塞症(VTE)物理预防的证据,提高护理人员VTE物理预防措施实施依从性。方法根据澳大利亚JBI循证卫生保健中心证据总结方法学,检索骨科围手术期患者VTE物理预防相关文献,根据纳入文献类型,由研究人员独立进行质量评价,并提取、汇总最佳证据。结果共纳入文献17篇,包含10篇指南、1篇证据总结、2篇专家共识、4篇系统评价。经过分析,总结出7类共30条骨科围手术期患者VTE物理预防最佳证据。结论最佳证据可为护士提供循证依据。但在应用时,还需评估具体临床情境,结合专业判断和患者意愿,针对性选择证据,以促进护理质量的持续改进。  相似文献   
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IntroductionThe risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill patients with COVID-19. Thus, this study aims to compare the effectiveness and safety of standard versus escalated dose pharmacological venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19.MethodsA two-center retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the intensive care unit (ICU) at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or Unfractionated heparin 5000 Units three times daily were grouped under the “standard dose VTE prophylaxis and patients who received higher than the standard dose but not as treatment dose were grouped under ”escalated VTE prophylaxis dose“. The primary outcome was the occurance of thrombotic events, and the secondary outcomes were bleeding, mortality, and other ICU-related complications.ResultsA total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). In patients who received escalated dose pharmacological VTE prophylaxis, any case of thrombosis and VTE were similar between the two groups (OR 1.22;95 %CI 0.52–2.86; P = 0.64 and OR 0.75; 95% CI 0.16–3.38; P = 0.70 respectively). However, the odds of minor bleeding was higher in patients who received escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08–10.61; P = 0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95 %CI0.79–1.73; P = 0.43 and HR 1.08;95 %CI 0.76–1.53; P = 0.83, respectively).ConclusionEscalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous evidence regarding the optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.  相似文献   
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《Vaccine》2022,40(44):6431-6444
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.  相似文献   
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Objectives: Aims were to investigate the prevalence and risk factors of venous thromboembolism (VTE) in gynecologic malignancy cases. Value of screening tool (Caprini) for prediction of VTE was also assessed. Study design: A retrospective study of gynecologic malignancy subjects who underwent major gynecological operation via exploratory laparotomy at Thammasat University Hospital, Pathum Thani, Thailand from January 2015 to December 2020. Participants were categorized into VTE and non-VTE groups. Caprini score, associated laboratory and clinical factors of both groups were evaluated. Results: A total of 392 subjects were recruited into the study. Prevalence of VTE was 7.4 (29/392) percent. VTE was diagnosed in subjects with endometrial, ovarian and cervical cancer at percentage of 7.8 (15/192), 7.9 (11/138) and 5.7 (3/53), respectively. Demographic characters of both groups were comparable. VTE group had significant more Caprini score, platelets count and platelet lymphocyte ratio (PLR) than non-VTE group. Modified Caprini score (2 multiply Caprini score plus 1 multiply PLR) was generated for better VTE prediction. Sensitivity and specificity of Caprini (≥5.5) and modified Caprini scores (≥22.8) were 72.4 vs 39.4, and 79.3 vs 52.1 percent, respectively. Conclusion: Prevalence of VTE among gynecologic malignancy cases was 7.4 percent. The modified Caprini score was an alternative VTE predictive tool. Cut-off point of modified Caprini score at equal or more than 22.8 was proposed.  相似文献   
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子宫腺肌病(adenomyosis)是育龄期女性常见的良性疾病之一,主要临床表现为痛经、月经过多及不孕,严重影响患者的生活质量。近年来,国内外学者相继报道了30多例子宫腺肌病发生血栓性病变的病例,包括脑梗死、弥散性血管内凝血和静脉血栓栓塞症,这些病例多发生于月经期。分析这些患者的病变特点后发现,子宫腺肌病患者发生血栓性病变的危险因素包括炎症、组织因子表达增加、血糖类抗原125(CA125)水平升高、月经过多和子宫体积增大等。子宫腺肌病患者一旦发生血栓性病变,将增加临床上诊断和治疗的难度。了解子宫腺肌病患者凝血功能的变化和警惕其发生血栓性疾病的风险将有助于提高子宫腺肌病的诊疗准确率和安全性。  相似文献   
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BackgroundWorkforce reform has placed a significant focus on the role of non-medical prescribers in the healthcare system. Pharmacists are trained in pharmacology and therapeutics, and therefore well placed to act as non-medical prescribers.ObjectivesTo assess the safety and accuracy of inpatient medication charts within a pharmacist collaborative prescribing model (intervention), compared to the usual medical model (control) in the emergency department (ED). Another objective compared venous thromboembolism (VTE) risk assessment and prescribing, between intervention and control groups.MethodsAdult patients in ED referred for hospital admission were randomised into control or intervention by a block randomisation method, until the required sample size was reached. Medication charts were audited retrospectively by an independent auditor, using validated audit forms.ResultsIntervention group medication charts contained significantly fewer prescribing errors, omissions and discrepancies compared to the control group, and improved documentation of adverse drug reactions. VTE risk assessment and prescribing had higher guideline concordance in the intervention group compared to the control group.ConclusionsThis collaborative prescribing trial showed excellent results in safety and accuracy of pharmacist prescribing when compared to the usual medical model of prescribing. The admitting medical practitioner and extended scope pharmacist prescriber worked as a collaborative team in emergency, which improved Australian national prescribing safety indicators.  相似文献   
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静脉畸形(venous malformation,VM)是最常见的血管畸形,根据其临床和组织学特征目前主要可分为普通静脉畸形和特殊类型静脉畸形。特殊类型静脉畸形主要包括家族性皮肤黏膜VM、蓝色橡皮乳头样痣(Bean)综合征、球形细胞VM等。除普通VM外,其余VM多伴有多个部位的病变。近年来随着基因测序技术的发展,关于这些特殊类型VM的文献报道逐渐增多。本文将对这些特殊类型的VM进行简要概述,并对其发病机制的研究进展进行综述。  相似文献   
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