脊柱术后并发静脉血栓形成的预防与治疗

目的:探讨脊柱手术后静脉血栓形成的预防、治疗方法。方法:回顾本院2006年6月~2007年5月脊柱手术病例85例,均为腰椎骨折患者,术前预防性予低分子肝素皮下注射。术后予低分子肝素皮下注射加复方丹参注射液静脉滴注。结果:术后共发生静脉血栓5例,治疗后发生血栓患者症状均消失。结论:对脊柱手术前后应加强预防措施。     

我国ICU静脉血栓栓塞症护理预防的文献计量分析

[目的]了解我国重症监护室(ICU)静脉血栓栓塞症(VTE)护理预防的研究现状。[方法]检索中国知网(CNKI)、万方、维普、CBM数据库,检索时限从建库至2016年12月,纳入与ICU病人VTE护理预防相关的文献,采用文献计量分析法对文献的发表年份、地区、发表期刊、研究机构、关键词等进行统计分析。[结果]共纳入147篇文献,分别发表在78种期刊上,其中护理专业刊物15种。整体发文量呈上升趋势。高频关键词和聚类分析显示研究的主要方向有4个:综合护理干预、急性胰腺炎重症病人的集束干预、外科术后重症病人采用低分子肝素与早期活动的联合预防、重症颅脑损伤病人的早期护理干预。[结论]我国对ICU病人VTE的护理预防研究正在不断发展、研究范围较广,但文献质量不高、研究发展不平衡、期刊核心区尚未形成,应进一步加强研究与探索,提升研究深度和广度,提高VTE护理预防效果。     

凝血试验在癌症相关静脉血栓栓塞症诊断和治疗中的临床应用

静脉血栓栓塞症(venous thromboembolism,VTE)是癌症患者的主要并发症,而凝血试验则为VTE的预防和治疗提供了依据。癌症患者的凝血指标变化复杂,在进行VTE排除诊断、风险分层和疗效监测时,应用规则和评价标准与非癌症患者存在显著差异。目前,有充分循证证据且可安全用于临床的实验室指标很少,能够被纳入国际主流抗栓治疗指南的指标主要包括D-二聚体、血小板计数、肝素诱导的血小板减少症抗体以及常规凝血试验等,且这些指标的应用也多被限定于风险评估模型或验前概率评分的框架之下。     

静脉血栓栓塞症抗凝新药物

静脉血栓栓塞症（venous thromboembolism,VTE）是下肢深静脉血栓（deep vein thrombosis,DVT）和肺栓塞（pulmonary embolus,PE）的统称。VTE被认为是目前临床上的常见疾病,尽管我国的发病率至今尚无数据统计,然在美国大约每年至少有25万新发病例[1]。抗凝治疗在VTE治疗中的地位已无可质疑。伴随着美国胸科医师协会（American College of Chest Physicians,ACCP）关于VTE预防和治疗指南（第8版[2]和第9版[3]）在国内的推广,对于有罹患VTE高危因素的患者,如骨关节置换术后[4]、多发性外伤[5]等,积极地使用抗凝药物进行预防已深入人心。     

老年病人PICC置管后抗凝治疗预防上肢静脉血栓的疗效观察

[目的]探讨老年病人经外周置入中心静脉导管（PICC）同步抗凝治疗预防静脉血栓的效果。[方法]将120例留置 PICC 老年病人随机分为治疗组和对照组各60例,对照组PICC置管期间按常规方法预防静脉血栓发生,治疗组增加同步抗凝治疗即低分子肝素钙4100 U皮下注射,每日1次,连续使用7 d。观察两组上肢静脉血栓形成率和留置时间。[结果]治疗组静脉血栓发生率显著低于对照组,PICC置管时间显著长于对照组（均P〈0.01）。[结论]老年病人 PICC 置管同步抗凝治疗可显著减少静脉血栓形成,延长PICC置管时间,有利于病人顺利完成治疗。     

普通肝素与低分子肝素钠预防肺癌患者静脉血栓栓塞症的临床效果观察

目的探讨普通肝素与低分子肝素钠预防肺癌患者静脉血栓栓塞症(VTE)的疗效差异。方法选取96例肺癌患者作为研究对象,采用随机数表法将其分为2组,各48例。实验组采用低分子肝素钠注射预防VTE,对照组选用普通肝素预防VTE。对比2组VTE发生率、凝血功能指标和血小板计数(PLT)、动脉血气指标、不良反应发生情况和生存质量评分。结果治疗后,实验组VTE发生率为4. 17%,显著低于对照组16. 67%(P 0. 05);治疗前后,2组PLT、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)相比,差异均无统计学意义(P 0. 05);治疗后,2组患者动脉血二氧化碳分压[p(CO_2)]、动脉血氧分压[p(O_2)]与动脉血氧饱和度(SaO_2)均显著高于治疗前(P 0. 05),且实验组p(CO_2)、p(O_2)、SaO_2均显著优于对照组(P 0. 05); 2组不良反应发生率比较,差异无统计学意义(P 0. 05);出院时,2组患者生存质量均显著高于治疗前(P 0. 05),但2组出院时生存质量无显著差异(P 0. 05)。结论与普通肝素相比,低分子肝素钠预防肺癌患者VTE的效果更显著,对动脉血气指标、凝血功能指标和血小板的影响小,有助于提高患者生存质量。     

利伐沙班与传统抗凝药物在80岁以上静脉血栓栓塞症患者中的有效性与安全性对比

目的:比较利伐沙班与传统抗凝药物在80岁以上静脉血栓栓塞症患者中的有效性与安全性。方法:回顾性分析45例80岁以上静脉血栓栓塞症患者的临床资料。采用利伐沙班治疗28例(利伐沙班组),传统抗凝药物(低分子肝素联合华法林或单用低分子肝素)治疗17例(传统抗凝组)。比较两组患者治疗12个月内的复发、出血、死亡及总体有效率的差异。结果:两组患者基线资料差异无统计学意义。治疗12个月内,两组复发、出血、血栓相关死亡及抗凝总体有效率差异均无统计学意义。利伐沙班组及其肿瘤患者亚组的全因死亡均低于传统抗凝组(P0.05)。结论:利伐沙班与传统抗凝药物在80岁以上静脉血栓栓塞症患者中的有效性和安全性可能相似。     

神经内科住院患者并发静脉血栓栓塞症的临床特征分析

目的:探讨神经内科住院患者并发静脉血栓栓塞症(venous thromboembolism,VTE)的临床特征、治疗策略和出血风险.方法:回顾性分析2014年1月至2020年12月复旦大学附属中山医院收治的77例神经内科住院患者并发VTE的临床特征及治疗预后.结果:77例患者中,男性43例,女性34例,平均年龄(69....     

静脉血栓栓塞症的抗凝疗程及其影响因素

抗凝疗法是静脉血栓栓塞症(VTE)治疗,尤其是VTE二级预防治疗的重要部分.目前推荐的VTE二级预防的疗程一般为3～12个月.影响抗凝疗程的因素主要有初次VTE发作时是否具有易栓症、血栓诱发因素和临床特征,应根据每位患者的影响因素,权衡VTE复发的可能性和预防中出血的风险来决定疗程.疗程结束后还应重新评估影响因素和停止抗凝后VTE复发的风险决定是否延长抗凝时间.     

老年病人PICC置管后抗凝治疗预防上肢静脉血栓的疗效观察

[目的]探讨老年病人经外周置入中心静脉导管(PICC)同步抗凝治疗预防静脉血栓的效果。[方法]将120例留置PICC老年病人随机分为治疗组和对照组各60例,对照组PICC置管期间按常规方法预防静脉血栓发生,治疗组增加同步抗凝治疗即低分子肝素钙4 100U皮下注射,每日1次,连续使用7d。观察两组上肢静脉血栓形成率和留置时间。[结果]治疗组静脉血栓发生率显著低于对照组,PICC置管时间显著长于对照组(均P0.01)。[结论]老年病人PICC置管同步抗凝治疗可显著减少静脉血栓形成,延长PICC置管时间,有利于病人顺利完成治疗。     

A review of the practical advantages of low molecular weight heparin in the treatment of cancer-related venous thromboembolism

Patients with cancer, particularly those with metastatic cancer, are at high risk of venous thromboembolism (VTE), which places a huge burden on healthcare resources and can adversely affect patients' prognosis. In addition, VTE can have a negative impact on quality of life and increase the management challenges faced by physicians and nurses. Conventional long-term treatment using vitamin K antagonists, such as warfarin, presents many practical problems for cancer patients including frequent monitoring and dose adjustment, drug interactions, and disruption of anticoagulation for invasive procedures. The aim of this article is to review the potential advantages of using low molecular weight heparin (LMWH) in the treatment of cancer-related VTE in comparison to conventional therapy with warfarin or standard heparin. The potential advantages were determined via a literature review. LMWH is at least as effective as standard heparin or warfarin, and has been shown to have several benefits over warfarin in cancer patients. The simplicity of this therapy enables patients to be treated at home, and has been shown to have a positive impact on overall quality of life. The use of LMWH provides a treatment alternative to patients with cancer offering them hope and optimism regarding their care.     

肺癌合并静脉血栓栓塞症患者的危险因素及预后分析

目的探讨肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)发生的相关危险因素及VTE对预后生存的影响。方法回顾性收集2011年6月至2017年6月在中国医学科学院北京协和医学院肿瘤医院经细胞学或病理确诊为肺癌,接受系统性治疗的507例患者临床资料,分为VTE组(71例),非VTE组(436例)。单因素分析比较两组患者的临床特征、实验室检查结果,多因素logistic回归分析影响肺癌患者VTE发生的危险因素,Kaplan-Meier生存分析法绘制生存曲线。结果507例患者VTE发生率14.0%(71/507)。单因素分析示肺癌VTE组患者的Ⅲ~Ⅳ期、合并高血压病、心力衰竭、D-二聚体≥1.05mg/L、中心静脉置管(central venous catheter CVC)的比例显著高于非VTE组(P<0.05)。两组患者年龄、性别、卡氏体力状态评分(Karnofsky score,KPS)、体重指数(body mass index,BMI)、表皮生长因子(epidermal growth factor receptor,EGFR)基因突变、合并冠心病、糖尿病、心房颤动、化疗、放疗、白细胞计数、血小板计数、血红蛋白、甘油三酯、总胆固醇水平等变量比较,差异无显著性(P>0.05);多因素logistic回归分析显示:Ⅲ~Ⅳ期、合并高血压病、D-二聚体≥1.05mg/L、CVC是影响肺癌患者VTE发生的独立危险因素(P<0.05)。Kaplan-Meier生存分析法绘制生存曲线,VTE组患者中位生存时间42.0个月(95%CI:32.278~51.722),非VTE组为49.0个月(95%CI:44.234~53.766),差异有显著性(P=0.041)。结论临床分期Ⅲ~Ⅳ期、合并高血压病、D-二聚体≥1.05mg/L、CVC是肺癌患者VTE发生的独立危险因素,肺癌合并VTE的患者预后差,积极防治肺癌患者VTE相关危险因素,有助于降低VTE发生风险,改善患者预后。     

Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer?

Introduction  Cancer disease inducing an acquired hypercoagulable state is a well-established feature. Venous thromboembolism (VTE) occurs in 4% to 20% of the patients and is the second cause of mortality in cancer; VTE incidence is four to six times higher in cancer patients compared to other patients. In the last 10 years, important randomised clinical trials have clearly demonstrated that long-term use of daily subcutaneous low molecular weight heparin (LMWH) is more efficient than Vitamin K antagonists to treat VTE in cancer patients. First Italian, then American and more recently French national guidelines recommend the use of LMWH for 3 to 6 months for curative treatment of VTE in cancer patients with a clearly high level (A) of evidence. Despite convincing data, many physicians have not yet modified their clinical practice, doubting the tolerability of such a long period of subcutaneous injections. In fact, LMWH long-term use appears well tolerated and may also increase cancer patient survival. Objectives  The aim of this review is to present the scientific rationale for long-term daily subcutaneous LMWH in cancer patients, and to reinforce the favourable benefit/tolerance tolerability ratio with this specific antithrombotic strategy.     

乳腺癌患者发生静脉血栓栓塞症危险因素分析

目的 探讨乳腺癌患者发生静脉血栓栓塞症的危险因素.方法 回顾性分析自2014年7月至2020年3月新汶矿业集团莱芜中心医院收治的90例女性乳腺癌患者临床资料,根据静脉血栓栓塞症发生情况分为未发生静脉血栓栓塞症的A组(n=60)与发生静脉血栓栓塞症的B组(n=30).记录两组患者的年龄、体质量指数、糖尿病病史、冠心病病史...     

Risk stratification for the development of venous thromboembolism in hospitalized patients with cancer

Essentials

• The Khorana score is validated for risk of venous thromboembolism (VTE) in cancer outpatients.
• We conducted a multicenter analysis of medically hospitalized cancer patients.
• Patients with a higher Khorana score on admission were more likely to develop VTE.
• The Khorana score is predictive of in‐hospital, symptomatic VTE development.

Summary

Introduction

The Khorana score is a validated risk assessment score for estimating the risk of symptomatic venous thromboembolism (VTE) in outpatients with cancer. The objective of this study was to assess the Khorana score for predicting the development of VTE in cancer patients during hospital admission.

Methods

We conducted an analysis of consecutive, adult cancer patients hospitalized for medical reasons between January and June 2010 in three academic medical centers. Information on objectively diagnosed, symptomatic VTE during hospitalization, use of anticoagulant thromboprophylaxis (TP) and Khorana score variables at the time of admission was collected.

Results

A total of 1398 patients were included. Mean age was 62 years, 51.2% were male, and mean BMI was 25.9 kg m^?2. The most frequent reasons for hospitalization were chemotherapy administration (22.3%), followed by pain control and palliation (21.4%). The overall incidence of VTE was 2.9% (95% CI, 2.0–3.8%), occurring in 5.4% (95% CI, 1.9–8.9%) of the high‐, 3.2% (95% CI, 2.0–4.4%) of the intermediate‐ and 1.4% (95% CI, 0.3–2.6%), of the low‐risk groups. High‐risk patients were more likely than low‐risk patients to have VTE (OR, 3.9; 95% CI, 1.4–11.2).

Conclusion

The Khorana score is predictive of in‐hospital, symptomatic VTE development in cancer patients who are hospitalized for medical reasons and may be a useful tool for tailoring inpatient anticoagulant thromboprophylaxis.

     

影响毛细血管渗漏综合征预后的因素分析

目的 探讨影响毛细血管渗漏综合征(CLS)患者预后的相关因素.方法 对安徽省立医院重症医学科收治的191例出现CLS患者的临床资料进行回顾性分析,按疾病转归将患者分为3组:死亡组37例,治愈组132例,未愈组22例.将治愈组和死亡组患者在入院时、出现CLS时和出院前的各项临床资料进行比较,探寻影响患者预后的相关因素.结果 与治愈组比较,死亡组患者的中心静脉压、血清白蛋白明显降低(P＜0.01),阴离子间隙、甘油三酯、压力调整心率、氧合指数也较低(P＜0.01或P＜0.05),血糖、全身性炎症反应综合征评分明显增高(P＜0.01);入院时出现肾损伤的患者较多(P＜0.01).在治疗方面,治愈组应用羟乙基淀粉氯化钠注射液、乌司他丁、连续性血液净化治疗者较多(P＜0.05).结论 发生CLS患者有效循环血量不足、严重低蛋白血症、内环境紊乱、营养状态较差、氧合指数低、肾损伤和全身炎症反应较重者,预后不良;应用羟乙基淀粉氯化钠注射液、乌司他丁、血液净化治疗,可能有助于改善CLS患者的预后.     

Fixed-dose low-molecular-weight heparin for secondary prevention of venous thromboembolism in patients with disseminated cancer: a prospective cohort study.

INTRODUCTION: Secondary prevention of venous thromboembolism (VTE) with vitamin K antagonists is often problematic in patients with cancer. We prospectively evaluated the effectiveness and safety of long-term subcutaneous dalteparin in a series of consecutive patients with symptomatic VTE and metastatic cancer. PATIENTS AND METHODS : The study included 203 patients, aged 36-96 years. The initial treatment consisted of a 7-day course of subcutaneous dalteparin according to body weight. Then, patients received a fixed dose of 10 000 IU dalteparin once daily for at least 3 months. In patients developing transient thrombocytopenia the dose was reduced to 5000 IU daily while the platelet count remained <50,000; and to 2500 IU daily while it remained <10 000. Patients undergoing any surgical intervention during the study were put on 5000 IU daily during the first 4 days, switching thereafter to 10,000 IU. Patients undergoing any other invasive procedure (i.e. biopsies, punctures) received a 5000 IU dose the same day, instead of 10 000 IU. RESULTS: Eleven patients (5.4%) developed major bleeding complications (6 fatal) during the 3-month study period, and 18 patients (8.9%) developed VTE recurrences (2 patients died). There were no higher complication rates in patients with either liver or brain metastases, nor during thrombocytopenia, surgery or invasive procedures. CONCLUSIONS: Fixed dose 10,000 IU subcutaneous dalteparin once daily for 3 months was not associated with more complications in patients with liver or brain metastases. The dose adjustment for patients with thrombocytopenia, surgery or invasive procedures was safe too.