综合防治法预防人工髋关节置换术后静脉血栓栓塞

目的探讨人工髋关节置换术后静脉血栓栓塞的预防。方法2004年2月~2005年12月行人工全髋关节置换术43例、人工股骨头置换术26例。对所有患者均进行了由纤溶酶静脉滴注,踝关节主、被动“环转”运动及持续被动活动机(CPM)治疗等组成的静脉血栓栓塞综合防治。结果69例患者在观察期内均未出现下肢深静脉血栓栓塞及肺栓塞表现,二维彩色多普勒超声检查示静脉血流通畅。结论综合防治对于预防人工髋关节置换术围手术期静脉血栓栓塞的发生具有积极的临床意义。     

人工髋关节置换术后关节脱位的预防与护理

目的探讨人工髋关节置换术后安全有效的护理措施,以避免和减少人工髋关节置换术后的关节脱位。方法对104例人工髋关节置换术后患者肢体保持15°外展中立位,搬运及使用便盆时应将骨盆整个托起,保持水平抬高,指导活动、休息时做到三不要:不要内旋内收膝关节,不要交叉双腿,不要坐在低于小腿高度的椅凳和沙发上,弯腰拾物时保持髋部外展中立位,并结合做好心理护理。结果104例人工髋关节置换术后仅有2例发生关节脱位,发生率为1.9%。结论认真细致做好人工髋关节置换术后的康复护理工作,分析引起关节脱位的原因,采取安全有效的预防护理措施,是减少术后髋关节脱位的关键。     

人工髋关节置换术后护理

目的讨人工髋关节置换围手术期护理。方法过对人工髋关节置换术病人的系统观察,制订有效的整体护理流程,以提高术后病人的生活质量。结果士护理质量得到显著提高,病人满意度提高。结论护理工作中,实行系统化,人性化护理,提升了护士的整体素质,促进了护患关系的全面提高。人工髋关节置换术是用人工髋关节代替已无法正常使用的病损髋关节,解决疼痛、畸形和功能障碍,恢复和改善髋关节运动功能的手术,是一种较为有效的关节成形术,从而改善病人的自理能力。但病人年龄普遍较大,术后并发症多,术后翻修等问题日趋明显。术前后的循证护理对如何避免手术并发症和手术翻修有重要意义,能有效地恢复关节功能,解除疼痛,从而提高患者的生命质量。     

人工髋关节置换术后静脉血栓的预见性护理

目的:探索预见性护理干预对髋关节置换术后静脉血栓形成的影响。方法:将120例髋关节置换术病人随机分为观察组和对照组,每组60例,观察组采用预见性护理,对照组采用常规护理和健康教育。观察并比较两组病人术后静脉血栓发生情况。结果:观察组病人术后静脉血栓发生2例(3.33%),对照组9例(15.00%),观察组明显少于对照组(P<0.05)。结论:预见性护理干预能有效降低髋关节置换术后下肢静脉血栓的发生率。     

人工髋关节置换术后下肢深静脉血栓的预防及干预措施

目的探讨人工髋关节置换术后下肢深静脉血栓形成的预防及护理方法。方法对38例实施人工髋关节置换术的患者,从一般护理,到给予预防性早期功能锻炼、间歇性压力治疗等综合性护理措施,同时配合低分子肝素等抗凝药物治疗。结果38例患者经有效预防及护理措施,均未发生下肢深静脉血栓。结论对人工髋关节置换术后患者采取有效的预防及护理措施,可以避免下肢深静脉血栓的形成。     

预防人工髋关节置换术并发症的护理

目的探讨预防人工髋关节置换术并发症的护理措施。方法回顾性分析1995—01／2007—01采用骨水泥型与非骨水泥型人工髋关节置换术，治疗老年股骨颈骨折46例和股骨头缺血坏死24例的资料。结果1例全髋关节置换术后脱位，经及时复位后未再脱位；1例髋关节早期感染，经关节冲洗引流加强抗感染后，伤口愈合；1例术后肺部感染呼吸衰竭死亡。术后随访时间1～12年，平均随访2．5年。髋关节功能采用Harris评分：优（〉90分）34例、良（80～89分）23例、尚可（70～79分）11例，差（〈70分）1例，优良率82．6％。结论预防人工髋关节置换术并发症的护理是一个有效、简单和安全的措施，能减少病死率和并发症发生率，减少住院时间和费用。     

人工股骨全髋关节置换术后护理

人工股骨全髋关节置换术是采用钛合金为材料,用工程学方法模拟人体髋关节,用以代替病变关节的一种功能重建术。我院近年来为20例患者施行该手术,表明手术可以达到解除疼痛、恢复功能及调整双下肢长度等治疗目的,对患者有一定的吸引力。现将该20例患者的术后护理要点,报告如下: 一、临床资料 本组股骨上端肿瘤患者20例,最大年龄61岁,最小19岁,男9例,女11例,均行人工股骨全髋关节置换术。2～2.5年髋关节松动4人,股骨髋针折断1人。按Harris评     

人工髋关节置换术后感染的治疗

目的 探讨人工髋关节置换术后感染的治疗方法.方法 回顾性分析2006～2009年我科所收治8例人工关节置换术后感染患者的临床资料.收集患者分泌物或关节穿刺液进行细菌培养、药敏试验.治疗包括:保留假体清创,VSD(vacuum sealing drainage)闭合冲洗3例;二期翻修5例.结果 3例保留假体清创闭合冲洗者,1例术后感染复发,后改为取出假体旷置,二期翻修.5例二期翻修者,术后均未见感染复发.所有患者均荻随访12～36个月,平均25个月,末次随访时,8例患者均未见感染复发.结论　人工髋关节置换术后感染的治疗方法以二期翻修较为理想.保留假体清创治疗应严格掌握适应证.     

人工髋关节置换术术后护理

目的：探讨38例人工全髋、18例半髋关节术后护理要点。方法通过严密观察病情,有效的心理护理,及时预防术后并发症预防,恰当进行功能康复锻炼。结果56例病人切口均Ⅰ期愈合,无并发症发生,术后患肢肿胀消退,疼痛缓解,髋关节活动度满意。结论通过人工髋关节置换术及术后护理,使患肢功能障碍降低到最低程度,从而提高病人的生活质量。     

人工髋关节置换术后病人的护理

目的 使人工髋关节置换术后的病人能得到有效的护理.方法 对25例人工髋关节置换术术后的病人进行病情观察和精心护理.结果 术后无一例发生并发症,均治愈出院.结论 通过人工髋关节置换术及术后护理,使患肢功能障碍降低到最低程度,改善和恢复关节功能,提高病人的生活质量.     

我院静脉血栓栓塞症风险评估及防范的应用研究

静脉血栓栓塞症是医院内非预期死亡的重要原因,通过对其实施风险评估及防范措施,提高医务人员对其的警惕性,加强医患沟通,有效防范因此引发的死亡医疗纠纷。     

妇科恶性肿瘤相关静脉血栓栓塞症的防治进展

摘要:目的 回顾妇科恶性肿瘤相关静脉血栓栓塞症的近期文献并对其发病概况、机制、风险因素、预防及治疗作一综述。方法 通过Pubmed、中国知网和万方数据库收集近期相关文献。结果 静脉血栓栓塞症是妇科恶性肿瘤患者常见并发症之一,对患者的预后和生存质量有着重要影响。结论 临床医师应高度重视妇科恶性肿瘤相关静脉血栓的预防,积极采取有效的措施进行防治。     

妊娠相关静脉血栓栓塞的危险因素及其预防决策

静脉血栓栓塞(VTE)是指静脉血管管腔内血液异常凝结,形成血栓而使血管完全或部分阻塞,引起血液循环障碍。VTE主要包括深静脉血栓形成(DVT)和肺栓塞,而颅内静脉窦血栓形成及卵巢静脉血栓形成等临床少见。VTE是一种非常严重,而且具有潜在致死性的妊娠并发症。孕产妇作为特殊人群,妊娠本身即为其发生VTE的危险因素,若同时合并其他可能导致VTE发生的危险因素,如孕前危险因素、产科危险因素及孕期新发或一过性危险因素等,均可导致妊娠期及产褥期妇女发生VTE的风险增高。临床如何识别VTE危险因素,并对这些高危因素进行相应管理,是产科临床亟待解决的难题。目前,我国孕产妇VTE死因构成比呈逐年上升趋势,但是迄今尚无孕产妇VTE管理的指南或专家共识。笔者拟主要参考现有的妊娠相关VTE的危险因素及其预防、诊治指南的研究证据,从妊娠期女性发生VTE的病因,妊娠期及产褥期孕产妇发生VTE的危险因素,妊娠相关VTE危险因素评估及妊娠相关VTE预防4个方面,阐述妊娠相关VTE危险因素、危险分级及其管理策略,旨在为我国妊娠相关VTE危险因素识别及规范管理,提供实用性临床指导。     

北京某大型综合医院术后静脉血栓栓塞症发生的危险因素分析

目的 探索北京某大型综合医院术后静脉血栓栓塞症(VTE)发生的危险因素,为临床预防和管理术后VTE提供参考依据。方法 检索病案首页数据,查询2012 - 2017年在北京某三甲医院进行外科手术治疗的患者,以出院诊断包含深静脉血栓形成(DVT)或肺血栓栓塞症(PE)的患者作为病例组,对照组采用1∶2匹配方法选择出院诊断无DVT或PE的患者,应用条件logistic回归分析术后VTE发生的危险因素。结果 （1）纳入试验组患者373例,对照组患者710例。高龄、麻醉时间长、术后卧床时间长是术后VTE的独立危险因素（P＜0.05）。（2）术前住院日长、术前采用血栓风险评估、术后采用物理抗凝措施是降低术后VTE风险的因素（P＜0.05）。（3）术后卧床时间对不同性别患者的术后VTE的发生风险影响不同;体腔开放性手术的术后卧床时间对术后VTE发生的OR值为1.24（95%CI:1.12～1.38）,高于腔镜手术（1.14,95%CI:1.09～1.19）。结论 高龄、麻醉时间长、术后卧床时间长的患者发生术后VTE的风险较高,而术前进行血栓风险评估、术后采取物理抗凝措施可以降低术后VTE的发生风险。     

Range of published estimates of venous thromboembolism incidence in young women

OBJECTIVE: This review was conducted to show the full range of incidence estimates published for venous thromboembolism (VTE) in women depending on study design and to suggest a more reliable estimate for women of reproductive age. METHODS: A literature search was performed to identify studies on the incidence of VTE in women. Incidence rates were compiled from studies with different methodologies and varying methodological quality. Algorithms were used to estimate VTE incidence from more reliable studies in young women. RESULTS AND DISCUSSION: The literature shows two levels of VTE incidence rates: community/cohort studies and database studies. The estimated VTE incidence for women of reproductive age was 5.5-13.5 and 3.8-12.2 in community and cohort studies, respectively, but only 0.7-3.8 per 10,000 women-years (WY) in database studies. This difference is probably attributable to methodological problems associated with some database studies. CONCLUSION: The VTE incidence in women of reproductive age is likely to be in the range of 5-10 per 10,000 WY. These rates for the background incidence are clearly higher than the reference figures that are often utilized in the comparison with users of hormonal contraception (0.5-1 VTE per 10,000 WY).     

Risk factors for recurrence of venous thromboembolism associated with the use of oral contraceptives

Background

Combined oral contraceptives (COC) increase the risk of venous thromboembolism (VTE), but the risk of recurrent VTE is not precisely determined. In this retrospective cohort study, we sought the risk factors for recurrence after a first VTE that occurred in women taking COC.

Study Design

Time-to-event analysis was done with Kaplan–Meier estimates. In total, 172 patients were included (43% with pulmonary embolism): 82% had no other clinical risk factor for VTE.

Results

Among the 160 patients who stopped anticoagulation, the cumulative incidence of recurrent VTE was 5.1% after 1 year and 14.2% after 5 years. Significant factors associated with recurrence were renewed use of COC [hazard ratio (HR)=8.2 (2.1–32.2)], antiphospholipid syndrome [HR=4.1 (1.3–12.5)] and protein C deficiency or factor II G20210A [HR=2.7 (1.1–7)]. Pure-progestin contraception [HR=1.3 (0.5–3.0)] or factor V Leiden [HR=1.3 (0.5-3.4)] did not increase recurrence. Postsurgical VTE had a lower risk of recurrence [HR=0.1 (0.0–0.9)].

Conclusion

Further studies are warranted to determine whether testing for antiphospholipid syndrome, protein C deficiency or the factor II G20210A could modify the duration of anticoagulation. This study confirms the safety of pure-progestin contraception.     

The association between extrinsic activated protein C resistance and venous thromboembolism in women

Recently, discussions have focused on the question of whether acquired APC resistance (APCsr) is a clue to the observed association between risk of venous thromboembolism (VTE) and OC use especially with the so-called third-generation OCs. It seems plausible that abnormalities in an extrinsic-based APCsr reflect an increased risk of VTE in women, but this has not yet been properly studied. The objective of our study was to determine whether there was an association of extrinsic APC resistance with VTE risk in a case-control study. Sixty-seven women with confirmed VTE diagnosis were consecutively recruited in primary health care settings, interviewed and blood samples were taken at least 6 months after VTE. Cases were age-matched to 290 population controls. Extrinsic APC resistance was measured as normalized APC ratio (APCsr). The effect of APC on tissue factor-initiated thrombin generation was measured in plasma using alpha2-macroglobulin attached thrombin activity as an endpoint. The extrinsic APCsr was significantly associated with factor V Leiden (FVL) mutation, both in the cases and in the controls. Also, in the women using OC, significantly higher values of APCsr were observed, which confirms the results of other studies. We did not identify a significant association between the extrinsic APCsr and VTE in women not using OC who are non-carriers of factor V Leiden using different approaches: comparison of medians, analyses with unconditional logistic regression using various cut-points of the APCsr distribution, and the comparison between the highest and the lowest quartile of APCsr. With all attempts, the risk estimates were close to unity. In conclusion, we were not able to find evidence for any association of extrinsic APCsr with VTE in women who were not using OCs and non-carriers of FVL.     

全髋关节置换术围手术期深静脉血栓形成防治的临床研究

目的 探讨全髋关节置换术围手术期深静脉血栓形成（DVT）的治疗措施.方法 回顾性分析300例行人工全髋关节置换术患者的临床资料.所有患者入院时均常规检测凝血功能,术后第1,3,5天监测D-二聚体（D-D）水平.疑似DVT患者,行下肢彩色多普勒超声检查,诊断不明确时行静脉造影.全部患者均接受物理治疗和预防性抗凝治疗.结果 术前共诊断DVT20例（30侧肢体）,中心型7例,周围型13例.所有患者进行术前抗凝治疗后,非DVT患者D-D水平呈逐渐下降趋势;DVT患者第1天和第3天D-D仍维持在高水平状态,平均D-D分别为6500,6800 μg/L.其他280例全髋关节置换术病例中共发现40例DVT.其中周围型DVT患者术后继续抗凝治疗6个月,中心型或混合型DVT患者骨科手术后放置临时腔静脉滤器,所有患者围手术期均未出现严重并发症.结论 全髋关节置换术患者术前需要充分监测评估,术后需早期进行功能锻炼,并联合抗凝治疗预防DVT.