围术期深静脉血栓形成

一、围术期深静脉血栓形成的发生率 深静脉血栓形成和肺栓塞是一个疾病的两个方面，近来人们倾向于将两者合称为静脉血栓栓塞（venous thromboembolism，VTE）。胭静脉以上（含胭静脉）深静脉血栓形成为近端深静脉血栓形成，胭静脉以下深静脉血栓形成为远端深静脉血栓形成。     

外科围手术期患者下肢深静脉血栓形成的原因及预防护理对策

[目的]探讨外科围手术期患者下肢深静脉血栓形成的原因及预防护理对策。[方法]对近期医学文献进行回顾性分析总结。[结果]术前认真评估，术中仔细操作，术后积极预防护理，可明显降低围手术期患者深静脉血栓形成的发生率。[结论]对于围手术期患者采取积极预防措施，减少DVT和肺栓塞的发生，降低患者住院日、医疗费用和病死率。     

中国普通外科围手术期血栓预防与管理指南

正随着人口老龄化不断进展和心血管疾病发病率上升,血栓栓塞性疾病的防治和处理逐渐受到各学科关注和重视。静脉血栓栓塞症(venous thromboembolism,VTE)包括肺血栓栓塞症(pulmonary embolism,PE)和深静脉血栓形成(deep vein thrombosis,DVT),PE和DVT是同一疾病不同阶段和不同部位的两种临床表现,二者统称为VTE。外科病人术前活动减少、术中制动和术后长期卧床均     

伴下肢深静脉血栓形成的老年髋部骨折围手术期处理

老年髋部骨折患者早期手术治疗的原则已得到广泛认同.有报道髋部手术深静脉血栓( DVT)发生率为40％～60％,约22％～29％的DVT患者可能发生致死性肺栓塞[1-2].因此对术前伴有DV的髋部骨折患者,进行正确的围手术期处理,避免DVT及肺栓塞的发生意义重大.现将2005～2010年手术治疗的235例老年髋部骨折患者中术前伴DVT的33例,回顾分析如下.     

外科病人并存糖尿病的特点及其围手术期处理

明确糖尿病病人围手术期血糖控制的安全方法。方法对６７例外科病人并存糖尿病时围手术期诊断与治疗时行回顾性分析。结果糖尿病以Ⅱ型多见,老年病人占７１．６％,病情隐戒,术前漏诊８例,术后因高渗性非酮症昏迷死亡１例,３例发生低血糖昏迷。结论静脉应用普通胰岛素是围手术期糖尿病人血糖控制的安全有效的方法。     

骨科围手术期血栓栓塞病的预防、诊断及治疗

在骨科临床领域，高龄手术患者、高能量多发伤患者及脊柱脊髓损伤患者是深静脉血栓形成（deep vein thrombosis，DVT）和肺栓塞（pulmonary embolism，PE）的高危人群”0。据统计，下肢矫形术后若不采用任何预防措施，下肢DVT发生率为40％～84％，其中近端DVT发生率为8％～24％，有症状的PE发生率为1．8％～7％，致命PE发生率为0．2％～2．0％，75％～90％的肺血栓来源于下肢、盆腔和下腔静脉。PE是骨科围手术期致残、致死率高的并发症之一。因此，预防和治疗骨科围手术期血栓栓塞病至关重要。     

骨科围手术期深静脉血栓形成危险因素的探讨

目的 研究骨科围手术期多种炎症因子的变化,探讨其对围手术期深静脉血栓形成(DVT)的危险性.方法 (1)76例急性骨折患者.测定术前白细胞介素(IL)-6、IL-8、一氧化氮合酶(NOS)和一氧化氮(NO)的含量.另32例健康体检者为对照;(2)14例择期骨科肢体手术使用止血带患者,分别测定再灌注前后血栓素B2(TXB2)、前列环素(6-Keto-PGFla)、IL-8、过氧化脂质(LPO)和NO含量.以7例未用止血带患者为对照;(3)15例择期人工髋关节置换手术者,分别测定手术前、手术后1、3、7、14 d LPO含量.结果 (1)与健康体检人员比较.急性骨折24 h IL-6、IL-8显著升高(P<0.01),NO和NOS显著降低(P<0.01);(2)与再灌注前相比,止血带组再灌注后10 min LPO显著升高(P<0.01);再灌注后18 min LPO、IL-8、TXB2、TXB<,2相似文献   

老年外科病人围手术期处理体会

随着社会老龄化，越来越多的外科老年病人需要手术治疗。老年病人并存疾病多，对手术的耐受性差。本院１９９７年至２０００年，共收治６５岁以上老年病人１０３例。现就围手术期处理的体会总结分析如下。临床资料１．一般资料：本组１０３例，男７３例，女３０例；年龄６５～８５岁，平均７３．４岁。其中胆石症２５例，胰腺癌５例，胃癌１９例，胃穿孔５例，结直肠癌２６例，肠梗阻６例，乳房癌５例，阑尾穿孔腹膜炎１２例。术前并存高血压病Ⅱ—Ⅲ期３８例，冠心病１８例，心电图改变３５例，肺气肿、肺心病２８例，糖尿病２５例，肝硬化…     

腹部外科围手术期下肢深静脉血栓的预防与治疗

下肢深静脉血栓（DVT）是腹部外科围手术期的常见并发症之一,其发病率高,致残、致死率高。腹部外科术后病人存在自身特定的以及手术相关的危险因素,进行围手术期血栓预防时须进行危险因素分层,并结合病人的出血风险的高低选择最佳预防方法。而下肢DVT的治疗则根据不同病人的不同情况选择抗凝治疗、溶栓治疗、机械性血栓清除或置入下腔静脉滤器。总之,腹部外科围手术期下肢深静脉血栓防治需个体化。     

严重脊柱侧凸患者围手术期并发症及其预防

目的：对严重脊柱侧凸患者围手术期并发症进行总结分析，并探讨其预防措施。方法：自1997年7月～2002年12月，矫治90。以上严重脊柱侧凸患者184例。手术分为4类：(1)先行Halo牵引、呼吸功能锻练1～3个月后，再行单纯后路矫形(4例)或前路松解2周后二期后路矫形(38例)；(2)前路松解，牵引2周后行后路矫形(112例)；(3)自体胫骨行前路支撑融合，2周后施行后路矫形(18例)；(4)一期前路骨骺阻滞加后路矫形(12例)。结果：牵引中并发短暂性神经损害9例；后路矫形术中心跳骤停1例(复苏成功)，术后下肢不全性瘫痪1例，肺部并发症10例。结论：严重脊柱侧凸患者的畸形僵硬、躯干倾斜明显，常伴有心肺功能减退或脊髓神经损害．其围手术期并发症的发生率较高。采取积极有效的措施可降低围手术期并发症的发生率。     

Deep Venous Thrombosis in Spine Surgery Patients: Incidence and Hematoma Formation

Deep venous thrombosis (DVT) is a significant health care problem; a variety of factors place spinal surgery patients at high risk for DVT. Our aim is to define the incidence of DVT occurrence in spite of prophylactic measures (mechanical and chemoprophylaxis), and the development of spinal epidural hematoma as a complication of chemoprophylaxis. In a single-center prospective study, 158 patients who underwent spinal surgical procedures were evaluated by clinical evaluation and lower limb Doppler ultrasonography imaging. Only one patient (0.6%) developed DVT; this patient was treated successfully without thrombus progression, with full recanalization. Three patients (1.8%) developed spinal epidural hematoma, but only one required surgical evacuation, and none sustained neurologic deficit. Careful evaluation for DVT risk on an individual basis and good prophylaxis helps to minimize the risk of DVT. The neurosurgeon is thus left to weigh the risks of postoperative hematoma formation against the benefits of protecting against DVT.     

Prevention of venous thromboembolism in spinal surgery

Deep vein thrombosis (DVT), and its most feared complication, pulmonary embolism (PE), still have a high incidence with high risk for patients health. Proven prophylactic measures are available but are generally underused, and DVT is still considered the most common cause of preventable death among hospitalized patients. The rationale for prophylaxis of venous thromboembolism is based on the clinically silent nature of the disease, the relatively high prevalence among hospitalized patients and the potentially tragic consequences of a missed diagnosis. During the last 15–20 years, spine surgery has changed radically, developing into a well-defined area of specialist surgery, and some attention is now being given to DVT events in spine surgery. The incidence of DVT during spine surgery is not documented in the literature, because only case reports or retrospective studies are reported. It would therefore be very helpful to initiate a multicenter study in order to understand this problem better and to develop, if possible, some guidelines on prophylactic measures in spine surgery. In doing so, we need to consider each patients pattern, any risk factors and every kind of surgical technique related to DVT, in order to improve the outcome of the patient and to reduce any medicolegal problems that could arise from a thrombotic complication or an epidural hematoma, with its high potential for irreversible consequences.     

Prevalence of Thrombophilias in Patients Presenting for Bariatric Surgery

Background  The rise in bariatric surgery has driven an increased number of complications from venous thromboembolism (VTE). Evidence supports obesity as an independent risk factor for VTE, but the specific derangements underlying the hypercoagulability of obesity are not well defined. To better characterize VTE risk for the purpose of tailoring prophylactic strategies, we developed a protocol for thrombophilia screening in patients presenting for bariatric surgery at our institution. Methods  Between April 2004 and April 2006, 180 bariatric surgery candidates underwent serologic screening for inherited thrombophilias (Factor V-Leiden mutation, low Protein C activity, low Protein S activity, Free Protein S deficiency) and acquired thrombophilias (D-Dimer elevation, Fibrinogen elevation, elevation of coagulation factors VIII, IX, and XI, elevation of Lupus anticoagulants and homocysteine level, and Antithrombin III deficiency). Prevalence rate of each thrombophilia in the subject group was compared to the actual prevalence rate of the general population. Results  Most plasma markers of both inherited and acquired thrombophilias were identified in higher than expected proportions, including D-Dimer elevation in 31%, Fibrinogen elevation in 40%, Factor VIII elevation in 50%, Factor IX elevation in 64%, Factor XI elevation in 50%, and Lupus anticoagulant in 13%. Conclusions  Obesity is a well-described demographic risk factor for VTE. In bariatric surgery candidates routinely screened for serologic markers, both inherited and acquired thrombophilias occurred more frequently than in the general population, and may therefore prove to be useful for individualized VTE risk assessment and prophylaxis.     

膝髋关节置换术围手术期血浆D-二聚体动态监测及临床意义

目的探讨膝、髋关节置换（TKA、THA）围手术期患者血浆D-二聚体动态变化规律并对其进行比较。方法采用免疫比浊法于术前、术后1、3、7、14d测定61例TKA、THA患者围手术期血浆D-二聚体水平,其中男15例,女46例;年龄33～82岁,平均（63.62±10.75）岁。TKA手术36例,其中单侧TKA手术25例,19例使用止血带、6例不使用止血带;双侧同期TKA11例,均使用止血带。单侧THA手术25例。术前、术后7d下肢彩超检查有无深静脉血栓形成。结果术前所有患者均未发现DVT,术后有1例单侧TKA发现右胫后静脉深静脉血栓,发生率1.6%。测得患者术前、术后第1、3、7、14第测得的D-二聚体值分别为（0.39±0.41）、（2.18±1.72）、（0.85±0.39）、（1.32±0.85）、（1.38±0.97）μg/ml,其差异具有统计学意义（F=21.873,P〈0.05）。术后第1天达最高峰。单侧TKA组与单侧THA组比较差异有统计学意义（F=4.216,P〈0.05）,其中术后第1天单侧TKA组明显高于单侧THA组（t=2.251,P〈0.05）;单侧TKA组与双侧TKA组比较差异有统计学意义（F=5.944,P〈0.05）,其中术后第7、14天单侧TKA组均明显低于双侧TKA组（t=2.832,P〈0.05;t=3.110,P〈0.05）;单侧TKA止血带组与非止血带组比较差异无统计学意义（F=2.125,P〉0.05）。结论 TKA、THA术后血浆D-二聚体水平均升高;TKA术后血浆D-二聚体水平明显高于THA。双膝同期TKA术后D-二聚体水平高于单侧TKA。     

经股静脉切开行下肢深静脉取栓术的安全性与易行性

目的探讨对急性期下肢深静脉血栓形成行股静脉切开取栓术的安全性与易行性。方法2003年6月～2006年8月对43例下肢深静脉急性血栓形成,急诊放置下腔静脉滤器行股静脉切开下肢深静脉取栓术,术后辅以抗凝、区域性溶栓。结果手术时间55～115 min,平均92.6 min。术中出血量100～1000 ml,平均384.6 ml,仅4例接受输血。术中5例发生一过性血压波动,很快恢复。术中及术后均无肺栓塞发生。术后5例发生腹股沟切口淋巴漏,均1周内愈合;1例老年患者卧床性肺炎,治疗后痊愈;无其他片发症发生。术后患肢肿痛缓解迅速,双下肢周径差值分别由术前的5.5 cm（中位数,膝上）、4.0 cm（中位数,小腿）降为1.5 cm（Z=-5.345,P=0.000）、1.0 cm（Z=-5.461,P=0.000）。32例随访6个月,未见血栓复发。结论经股静脉切开深静脉取栓术操作易行,安全,术后早期症状缓解明显。对于急性期累及髂股静脉的较严重的下肢深静脉血栓可以考虑手术取栓。