Padua量表在内科住院患者静脉血栓栓塞症中的应用研究进展

静脉血栓栓塞症(VTE)在内科住院患者中的发生率逐年升高,内科住院患者疾病复杂、病情严重、合并静脉血栓风险因素较多,是发生VTE的高危人群.VTE是可防可控性疾病,早发现早治疗能够显著降低改善患者预后,提高患者生活质量.Padua量表是目前国内外指南推荐用于内科住院患者VTE筛查的最优模型,现就Padua量表在国内外内...     

静脉血栓栓塞护理小组的建立及管理

为了更好的规范院内静脉血栓的护理工作,为住院患者提供规范、统一的静脉血栓栓塞症(venous thromboembolism,VTE)护理,2012年成立了院内VTE护理小组,其包括5个亚组,分别为:知信行组、风险评估组、指南组、治疗组、信息组,采用三阶梯对VTE护理小组和全院护士进行培训。经过5年的实施,护士VTE的认知水平从(53.48±11.56)分提高至(58.36±14.68)分,VTE护理小组的成立提高了护士对VTE的认知水平,规范了护士对患者静脉血栓栓塞症的管理。     

复方丹参预防沙利度胺引起静脉血栓症的临床观察

静脉血栓栓塞症(VTE)包括深静脉血栓形成(DVT)及肺栓塞(PE),是一种严重威胁生命的疾病.美国临床肿瘤学会癌症患者静脉血栓栓塞防治指南指出,肿瘤患者尤其是卧床及住院接受化疗期间发生VTE的风险极高,并且早期病死率高.     

住院患者静脉血栓栓塞症的风险评估:护理的价值

静脉血栓栓塞症(VTE)是住院患者常见的并发症之一,住院患者可能存在VTE高危因素。护理作为VTE防治的重要组成部分,护士应准确识别危险因素、及时正确进行VTE风险评估,采取恰当的预防措施对预防VTE意义重大。     

内科住院癌症患者静脉血栓栓塞症认知现状及影响因素分析

目的:探讨内科住院癌症患者对静脉血栓栓塞症(VTE)认知现状,并分析其影响因素。方法:采用便利抽样法,选取2018年8月10日～11月10日在某综合三级甲等医院内科病房住院的癌症患者220例,使用中文版VTE认知情况调查问卷评估患者VTE认知现状并分析其影响因素。结果:本组患者认知深静脉血栓形成(DVT)、肺血栓栓塞症(PE)和血栓形成等健康状况者分别为55例(28.8%)、79例(41.4%)和97例(50.8%),知晓DVT和PE临床表现者分别为40例(20.9%)、54例(28.3%);是否留置PICC、受教育程度是内科住院癌症患者对VTE认知的影响因素(P0.05,P0.01)。结论:内科住院癌症患者对VTE认知不足,其认知情况与是否留置PICC、受教育程度有关。因此,医务人员需结合患者的社会背景及VTE认知具体情况,有针对性地进行健康教育,提高患者VTE认知度,从而预防VTE发生。     

护士主导的静脉血栓栓塞症防控管理

目的建立护士主导的静脉血栓栓塞症(venous thromboembolism,VTE)防控管理流程,评价其实施效果。方法将择期入院治疗的患者按入院时间分组,其中2018年1月—6月的住院患者为对照组,实施常规的VTE管理方法;2019年1月—6月的住院患者为试验组,采用护士主导的VTE防控管理流程,包括风险评估、出血风险评估、防控措施执行。比较两组患者静脉血栓栓塞症的发生率、早期诊断率、住院天数及住院费用。结果实施规范化防控管理流程后,患者静脉血栓栓塞症的发生率、早期诊断率、平均住院日及平均住院费用均有改善(P0.001)。结论护士主导的静脉血栓栓塞症防控管理流程的建立与实施有效降低了住院患者VTE的发生率,促进了VTE护理水平的提升。     

静脉血栓栓塞的预防[英]

最近英国卫生部门公布了对手术病人如何预防静脉血栓栓塞（VTE）的新指南,主要针对18岁及以上的住院手术病人,其是VTE的高危人群。本文介绍卫生保健部门关于住院手术病人VTE的预防。     

住院患者静脉血栓栓塞症风险管理体系的建立与临床实践

目的:建立并实践住院患者静脉血栓栓塞症(Venous Thrombo-embolism,VTE)风险管理体系,评价其实施效果。方法:成立医院护理部VTE专科护理小组,通过文献回顾、结合临床实际,采用焦点小组访谈法获得住院患者静脉血栓栓塞症风险管理体系的内容并临床实践,对实施效果进行分析。结果:风险管理体系实施后,临床护士VTE风险防范意识显著提高,近三年管理VTE患者数量成明显上升趋势,结合信息系统,识别VTE高危科室,开展进一步护理。结论:住院患者静脉血栓栓塞症风险管理体系的建立与临床实践对提升护士VTE护理能力、改善VTE患者疾病管理现状、推动VTE专科护士培养有促进作用。     

结合《中国骨科大手术静脉血栓栓塞症预防指南(2016版)》谈血栓标志物的应用北大核心

2016版《中国骨科大手术静脉血栓栓塞症预防指南》已成为临床骨科大手术病人预防静脉血栓栓塞症(VTE)的重要指引,作为纲领性文件为静脉血栓栓塞症的预防提供了依据。该指南融汇了临床多学科经验和大量循证医学证据,显著降低了临床骨科大手术病人的血栓发生率。现从医学检验视角结合新型血栓标志物学习该指南,发现尚有较大提升空间,故针对部分条款进行解读,并提出建议,期待能为该指南的更新提供参考依据。     

Padua评分和“中国专家建议”对神经内科住院患者VTE风险的预测价值比较

目的探讨Padua评分和《内科住院患者静脉血栓栓塞症预防中国专家建议》(简称“中国专家建议”)对神经内科住院患者静脉血栓栓塞症风险的预测作用。方法采用方便抽样法,选取281例神经内科住院患者为研究对象,使用一般资料调查表、Padua评分、“中国专家建议”进行调查;通过绘制ROC曲线,比较两种方法对神经内科住院患者静脉血栓栓塞症的预测能力。结果有12例患者出现静脉血栓栓塞症,发生率为4.3%;Padua评分与“中国专家建议”的ROC曲线下面积分别为0.934(95%CI=0.881~0.987,P<0.001)和0.781(95%CI=0.654~0.908,P=0.001)。Padua评分预测神经内科住院患者并发VTE的最佳截断值为4分,灵敏度为83.3%,特异度为85.5%。结论Padua评分和“中国专家建议”均能在一定程度上预测神经内科住院患者静脉血栓栓塞症的发生风险,其中“中国专家建议”可以用于即时评估,适用于新入院患者静脉血栓栓塞症的早期筛查;Padua评分的预测能力更好,更适用于患者住院期间静脉血栓栓塞症风险的动态评估。     

Prophylaxis of venous thromboembolism

Most hospitalized patients present risk factors for venous thromboembolism (VTE). Deep vein thrombosis and pulmonary embolism are relevant causes for morbidity and mortality in the perihospital phase, with a possibly fatal outcome. Surgical as well as nonsurgical patients with acute medical illness are at risk and show comparatively high rates of VTE. Because of this, an effective and safe prophylaxis for hospitalized patients is necessary. Definition of different risk categories and treatment of patients according to the individual risk profile is standard in VTE prophylaxis. For VTE prophylaxis various medical and mechanical options are available.     

Venous thromboembolism in medically ill patients: identifying risk and strategies for prevention

Venous thromboembolism (VTE) is a condition that has multiple causes but few warning signs. Consequently, the 2 manifestations of VTE-pulmonary embolism and deep vein thrombosis-often go unpredicted. This is especially true for medical patients. Treatment guidelines indicate that most hospitalized patients should receive prophylaxis for VTE. This report discusses these guidelines, the high prevalence of VTE among medical patients, and clinical studies of thromboprophylaxis in medically ill patients. VTE prophylaxis continues to be underutilized in medically ill patients. These patients are at significant risk of VTE and require prophylaxis, an objective that is supported by the recent guidelines of the American College of Chest Physicians. In addition, several lines of clinical evidence support the use of prophylaxis in this subgroup of patients. Improved systems are needed in medically ill patients to help improve outcomes and compliance for the use of VTE prophylaxis.     

A need for a simplified approach to venous thromboembolism prophylaxis in acute medical inpatients

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the UK. Studies have shown that pulmonary embolism causes or contributes to approximately 1 in 10 hospital deaths of medical patients admitted to general hospitals in the UK (Lindblad B, Sternby NH, Bergqvist D. BMJ 1991; 302: 709-11), with pulmonary embolus being the most common preventable cause of hospital death. Thromboprophylaxis is safe, highly effective and cost effective, but despite various current clinical guidelines, physicians fail to prescribe prophylaxis for the majority of medical inpatients at risk of VTE. This article outlines the current evidence for VTE prophylaxis in medical patients and discusses the reasons behind the insufficient use of prophylaxis in the acute medical setting.     

脊柱外科手术后静脉血栓栓塞症自然发生率的临床研究

目的 分析脊柱手术后静脉血栓栓塞症（VTE）的自然发生率,探讨采取干预措施抗凝以预防VTE的必要性;结合文献,分析VTE的发生与手术方式、体位、时间等关系,指导临床改进相关环节.方法 2011年1月至2012年1月收治的接受脊柱手术患者168例,术前进行血常规、凝血指标及双下肢静脉彩超检查.术后复查双下肢静脉彩超.随访时间3个月.如果彩超怀疑深静脉血栓（DVT）,行下肢静脉造影确诊;如果高度怀疑肺栓塞（PE）形成,行肺血管造影确诊.统计患者资料及VTE例数.通过SPSS 11.0软件,利用x2检验、Mann-Whitney检验分析.结果 168例患者中确诊VTE1例,无PE病例.脊柱手术后VTE自然发生率为0.60％.尝试分析VTE阳性组与阴性组在性别、年龄、体重、手术时间、部位、入路、失血量、卧床时间等方面是否存在统计学差异.但由于VTE阳性例数少,随机性大,未能进行分析.结论 本次研究结果与文献报道类似,显示脊柱手术围手术期不采用抗凝措施下,VTE自然发生率较低;脊柱手术后对于无VTE症状以及不存在VTE危险因素的患者不需要行双下肢静脉彩超检查、血管造影检查以及常规抗凝处理.     

Benefits of more aggressive VTE prophylaxis in hospitalized medical patients

Venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism, is a well-known risk in surgical patients, but it is also a significant and often unrecognized source of mortality and morbidity in hospitalized medical patients. The need for routine prophylaxis in the general medical population is increasingly supported.     

The importance of appropriate prophylaxis for the prevention of venous thromboembolism in at‐risk medical patients

Background: Venous thromboembolism (VTE), which encompasses both deep‐vein thrombosis and pulmonary embolism, is a significant healthcare problem, leading to considerable morbidity, mortality and resource utilisation. Aims: This review discusses the adherence to VTE guideline recommendations and the available clinical evidence on the appropriate type, dose and duration of VTE prophylaxis. Methods: A literature survey was conducted using Pub Med and EMBASE to identify publications related to appropriate thromboprophylaxis in medically ill patients at risk of VTE. Results: Despite evidence from clinical trials and national guidelines, VTE prophylaxis in medically ill patients remains underutilised. The use of unfractionated heparin three‐times‐daily, low‐molecular‐weight heparin once‐daily and fondaparinux once‐daily has demonstrated effectiveness in clinical trials of medically ill patients. However, controversy exists about the use of unfractionated heparin twice‐daily, and fondaparinux has not yet received US Food and Drug Administration approval for VTE prophylaxis in medically ill patients. Conclusion: It is important for clinicians to have an understanding of the evidence‐based literature when selecting an appropriate drug, at the appropriate dose, for the appropriate duration for VTE prophylaxis in medically ill patients. VTE prophylaxis in medically ill patients is cost‐effective, and drugs that are expensive may still be cost‐effective when considering improved efficacy and/or safety. Recently, the underutilisation of VTE prophylaxis has led to the involvement of government and other regulatory agencies in an attempt to increase appropriate VTE prophylaxis in US hospitals and improve the clinical and economic outcomes in medical patients at risk of VTE.     

Venous thromboembolic prophylaxis: the use of aspirin

Venous thromboembolism (VTE) is a term used collectively for deep vein thrombosis (DVT) and pulmonary embolism. Without prophylaxis, the incidence of documented DVT in the orthopaedic surgery patient is reported in the range of 50%-60%. A multimodal approach to DVT prophylaxis is the standard of care for all patients undergoing total hip arthroplasty and total knee arthroplasty. At our local hospital, low-risk patients are being sent home with aspirin as the medication for VTE prophylaxis. This article will provide an overview of the pathophysiology of VTE and the current prevention guidelines including the use of aspirin.     

Venous thromboembolism risk and prophylaxis in the acute hospital care setting: report from the ENDORSE study in Egypt

ABSTRACT: BACKGROUND: Venous thromboembolism (VTE) is a leading cause of hospital-related deaths worldwide. However, the proportion of patients at risk of VTE who receive appropriate prophylaxis in Egypt is unknown. The ENDORSE study in Egypt is part of a global initiative to uncover the incidence of high-risk surgical and medical patients and determine what proportion of these patients receive appropriate VTE prophylaxis. METHODS: Ten Egyptian hospitals participated in this observational study, enrolling all surgical and medical patients that met the study criteria. This resulted in a cohort of 1,008 patients in acute care facilities who underwent a retrospective chart review. Each patient's VTE risk status and the presence or absence of appropriate prophylactic care was assessed according to the American College of Chest Physicians (ACCP) guidelines 2004. RESULTS: Of the 1,008 patients enrolled, 395 (39.2%) were found to be at high-risk for VTE. Overall, 227 surgical patients were at high-risk, although only 80 (35.2%) received ACCP-recommended prophylaxis. Similarly, 55/268 (32.75%) of high-risk medical patients received appropriate VTE prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant, while mechanical prophylactic use was quite low (1.5%) in high-risk patients. CONCLUSIONS: In Egypt, more than one-third of all patients hospitalized for surgery or acute medical conditions are at high risk for developing VTE. However, only a small fraction of these patients receive appropriate VTE prophylaxis. Corrective measures are necessary for preventing VTE morbidity and mortality in these high risk patients.     

The AVAIL ME Extension: a multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis

Summary. Background: Venous thromboembolism (VTE) is a major worldwide problem. Objectives: The primary objectives of this survey were to identify patients at risk for VTE, to define the rate of patients receiving appropriate VTE prophylaxis and to examine the frequency of the presence of guidelines and their application. Patients and methods: Ten countries, 101 hospitals and a total of 4983 patients were included in this multinational cross‐sectional survey. Standardized case report forms were filled out by trained individuals on one predefined day. Risks were categorized according to the Caprini Risk Assessment Model. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. Results: Of 4983 patients, 3368 (68%) and 1615 (32%) were surgical and medical, respectively. Seven hundred and seventy‐two (15.5%) were considered to be at low risk, 1001 (20%) at moderate risk, 1289 (26%) at high risk and 1921 (38.5%) at very high risk for VTE. Of 3575 (72%) patients who were eligible to receive VTE prophylaxis, 2747 (77%) received any drug prophylaxis. Among these patients 720/1056 (68%) and 2027/2519 (80%) were medical and surgical patients, respectively. The overall compliance with ACCP guidelines was 38%, being 24% for medical patients and 44% for surgical patients. Conclusions: The results of this large multinational survey, although indicating overall improvement in VTE prophylaxis, identify a considerable number of patients who either did not receive any VTE prophylaxis or received it inappropriately. Although more medical patients were at risk for VTE, they were given prophylaxis less frequently than surgical patients. Concordance with VTE prophylaxis guidelines was higher in surgical patients, but overall application of these tools was unacceptably low.