中国骨科大手术静脉血栓栓塞症预防指南

骨科大手术后静脉血栓栓塞症（venous thromboembolism,VTE）的发生率较高,是患者围手术期死亡的主要原因之一,也是医院内非预期死亡的重要原因。对骨科大手术患者施以有效的预防方法,不仅可以降低发生静脉血栓栓塞症的风险,减轻患者痛苦,大量的医药经济学研究证实还可降低医疗费用。为提高与骨科相关的静脉血栓栓塞症的预防水平、规范预防方法,特制订“中国骨科大手术静脉血栓栓塞症预防指南”。本指南中的“骨科大手术”特指人工全髋关节置换术（total hip replacement,THR）、人工全膝关节置换术（total knee replacement,TKR）和髋部周围骨折手术（hip fractures surgery,HFS）。本指南仅为学术性指导意见,具体实施时必须依据患者的医疗情况而定。     

中国创伤骨科患者围手术期静脉血栓栓塞症预防指南(2021)

静脉血栓栓塞症(venous thromboembolism,VTE)是创伤骨科患者的常见并发症,也是导致患者围手术期死亡的主要原因之一。对创伤患者施以有效的预防措施,可以降低VTE的发生风险,减轻患者痛苦,减少医疗费用。因此,参照2016版"中国骨科大手术静脉血栓栓塞症预防指南"、2018版"中国血栓性疾病防治指南"及最新的循证证据,在2012版"中国骨科创伤患者围手术期静脉血栓栓塞症预防的专家共识"基础上,制定本指南。     

中国骨科大手术静脉血栓栓塞症预防指南

骨科大手术后静脉血栓栓塞症(venous thromboem-bolism,VTE)发生率较高,是患者围手术期死亡的主要原因之一,也是医院内非预期死亡的重要原因.对骨科大手术患者施以有效的预防方法,不仅可以降低发生静脉血栓栓塞症的风险,减轻患者痛苦,大量的医药经济学研究证实还可降低医疗费用[1].为提高骨科相关静脉血栓栓塞症的预防水平、规范其预防方法,特制订"中国骨科大手术静脉血栓栓塞症预防指南".本指南中的"骨科大手术"特指人工全髋关节置换术(total hip replacement,THR)、人工全膝关节置换术(totalknee replacement,TKR)和髋部周围骨折手术(hip fractures surgery,HFS)[2].本指南仅为学术性指导意见,具体实施时必须依据患者的医疗情况而定.     

静脉血栓栓塞症临床决策支持系统的构建及应用

目的 构建深静脉血栓栓塞症临床决策支持系统及评价应用效果。方法 基于电子护理文书录入系统、医院运营管理决策分析系统,构建静脉血栓栓塞症临床决策支持系统,于2018年开始应用于静脉血栓栓塞症防控。结果 临床决策支持系统应用后,静脉血栓栓塞症预防率从2018年的88.00%提高到2020年的99.88%;全院静脉血栓栓塞症上报率从0.28%提高至0.44%,骨科静脉血栓栓塞症上报率由2.90%提高到3.95%(均P<0.01);全院有症状静脉血栓栓塞症发生率从0.07%下降至0.06%,骨科有症状静脉血栓栓塞症发生率由0.17%下降至0.03%(P<0.05,P<0.01)。结论 静脉血栓栓塞症临床决策支持系统为护士提供准确、客观的决策依据,促进静脉血栓护理行为规范化、服务标准化和品质同质化,有利于护理质量持续改进。     

临床决策支持系统用于静脉血栓栓塞症预防管理的研究进展

综述临床决策支持系统在静脉血栓栓塞症预防与管理中的应用情况,包括风险评估、指南应用、药物管理、诊断及复发评估,为进一步提高静脉血栓栓塞症预防及管理提供参考。     

恶性肿瘤患者静脉血栓栓塞症防治的研究进展

静脉血栓栓塞是恶性肿瘤患者常见的并发症,防治静脉血栓栓塞症也是恶性肿瘤综合治疗的一个重要组成部分,笔者就恶性肿瘤患者静脉血栓栓塞症的预防及治疗相关研究进展进行综述。     

中国骨肿瘤大手术静脉血栓栓塞症防治专家共识

静脉血栓栓塞症可使血管完全或不完全阻塞而引起静脉回流障碍,导致相应的机体变化。骨肿瘤患者行手术治疗的血栓栓塞症风险较高,目前国内尚无防治共识可供借鉴。中华医学会骨科学分会骨肿瘤学组组织全国三十多位专家,参考国内外相关领域的最新研究成果、指南或共识,总结骨肿瘤大手术静脉血栓栓塞症的流行病学特点、风险因素、诊断流程及防治措施,形成本共识。该共识的实施有望提高国内相关医师对骨肿瘤大手术静脉血栓栓塞症的认识及诊疗水平。     

老年人静脉血栓栓塞症的研究进展

目的总结现阶段老年人静脉血栓栓塞症的研究进展。方法复习近年来国内外有关老年人静脉血栓栓塞症的流行病学、危险因素、诊断、防治及预后方面的文献并进行综述。结果静脉血栓栓塞症对于老年人来说是较为常见的一类心血管系统疾病,其发生率较高,但老年人对其预防重视程度不够,其临床表现无年轻人明显。对老年人静脉血栓栓塞症,各种检查手段各有其优缺点,治疗以抗凝为主,但需注意出血风险。结论老年人静脉血栓栓塞症的发病率高,诊断措施多样,需要分类对待,治疗过程中的利弊尤其需要注意,加强其专门的研究更有必要。     

静脉血栓栓塞症患者护理随访系统的设计与应用

目的 设计针对静脉血栓栓塞症出院患者的护理随访系统,观察并评价其应用效果.方法 组建研究团队,基于护理程序设计结构化随访表单,构建静脉血栓栓塞症出院患者健康教育知识库,以医院信息系统为支撑平台构建结构化护理随访系统,于2018年1月正式投入使用,统计运行期间各质量评价指标及随访结果.结果 截至2020年6月,随访静脉血栓栓塞症患者3 417例(4 783例次),静脉血栓栓塞症出院患者电话随访通话成功率为96.78％.2018～2020年30 d内因静脉血栓栓塞症或静脉血栓栓塞症相关原因再入院率由3.60％降至2.88％;患者服药依从性、用药信息了解度及对护理服务满意度逐年提高.结论 基于护理程序设计的结构化护理随访系统可有效提升随访工作质量及效率,为高质量、规范化、同质化随访服务提供保障.     

《静脉血栓栓塞症诊断与治疗》出版

<正>由北京世纪坛医院血管外科主任张福先教授、中山大学附属第一医院院长血管外科主任王深明教授共同主编的《静脉血栓栓塞症诊断与治疗》一书由人民卫生出版社正式出版发行。本书由我国多位在静脉血栓栓塞症诊治和预防中经验丰富的著名血管外科专家与他们的团队共同撰写完成。全书共40章,约50万字。全书对静脉血栓栓塞症的病因、流行病学、发病机制、诊断、治疗、预防进行了全面系统和深入的阐述,涵盖的内容不仅有血栓形成机制与静脉血栓栓塞症关系的基础理论,还有静脉血栓栓塞症诊断和治疗的临床实践总结,其突出特点     

按《指南》预防人工髋关节置换术后静脉血栓栓塞症的有效性与安全性

目的 探讨按<中国骨科大手术静脉血栓栓塞症预防指南>(简称<指南>)预防人工髋关节置换术后静脉血栓栓塞症(VTE)的有效性和出血并发症的风险. 方法 2001年1月至2005年1月对402例患者行人工髋关节置换术,男119例,女283例;平均年龄63.2岁;其中股骨颈骨折278例,股骨头缺血性坏死78例,骨关节炎46例,没有按<指南>进行规范预防(A组);2009年1月至2010年1月对120例患者行人工髋关节置换术,男36例,女84例;平均年龄62.9岁;其中股骨颈骨折83例,股骨头缺血性坏死23例,骨关节炎14例,按<指南>实施基本预防措施和物理预防措施,药物预防于术后12 h开始皮下注射低分子量肝素至术后10 d,之后改用口服利伐沙班至术后21 d(B组).比较两组患者发生症状性VTE和出血并发症的比例. 结果 A组出现下肢深静脉血栓形成(DVT)83例,发生率为20.6%(83/402);出血并发症28例(7.0%,28/402).B组15例出现DVT,发生率为12.5%(15/120);出血并发症8例,发生率为6.7%(8/120).B组DVT的发生率低于A组,差异有统计学意义(χ2=4.022,P=0.045).两组出血并发症发生率差异无统计学意义(χ2=0.002,P=0.960). 结论按照<指南>对人工髋关节置换术患者术后VTE进行预防,提高了预防效果,同时不会增加出血的风险.     

Venous thromboembolism prophylaxis in urology: A review

Venous thromboembolism is potentially a lethal problem, and is associated with chronic morbidity. Venous thromboembolism is frequently diagnosed after urological surgery, yet the role of perioperative venous thromboembolism prophylaxis is not clearly defined. Any current recommendations are largely based on evidence derived from other surgical specialties. Even within different guidelines, there remains significant variation, suggesting a consensus is required. The present review aims to define the problem of venous thromboembolism within the urological population, and identifies patients at risk. It evaluates the role of various types of mechanical and pharmacological prophylaxis, along with its timing and duration of administration in common urological operations. The current guidelines are summarized and compared in order to give the reader a better perspective of this vital condition.     

Prevention of deep vein thrombosis and pulmonary embolus

Venous thromboembolism is common in the perioperative period and in hospitalized medical patients. Difficulties with diagnosis and the risks of treatment make prevention a clinical imperative. To minimize morbidity and mortality, all hospital patients should be assessed for the risk of thromboembolism and bleeding, in order to receive the appropriate prophylaxis. A range of mechanical and pharmacological interventions have been shown to significantly reduce the incidence of venous thromboembolism. Anaesthetic interventions can also modify risk. Newer oral anticoagulants have been developed for use after major orthopaedic surgery.     

美国血管外科学会2018年腹主动脉瘤诊治指南解读

根据循证医学的基本原则,美国血管外科学会（SVS）在系统性回顾的基础上,于2018年1月发布了腹主动脉瘤（AAA）治疗指南,针对AAA的诊断评估、治疗方式、麻醉及围术期处理、术后管理及随访、经济效益学分析5个方面做了重点阐述,并给出111条具体的推荐建议,并按GRADE法给出了推荐强度及证据级别。笔者对该指南中涉及的新观点或推荐意见、以及与临床诊疗过程中的密切相关点作一解读,以期读者更好的理解该指南。     

Primary prophylaxis of venous thromboembolism in surgical patients

Venous thromboembolism is a major risk for surgical patients during the perioperative period. Prevention of perioperative venous thromboembolism remains a critical component of surgical patient care. The risk for venous thromboembolism in surgical patients can be stratified by their risk factors and by the type of operation. Pharmacological prophylaxis for venous thromboembolism includes unfractionated heparin, low-molecular weight heparin, fondaparinux, warfarin, antiplatelet therapy, and direct thrombin inhibitors. Mechanical devices such as graduated compression stockings, intermittent pneumatic compressions, and venous foot pumps are also effective modalities for venous thromboembolism prophylaxis. The optimal preventive measure of venous thromboembolism should be based on the degree of risk for venous thromboembolism with the intensity of prophylaxis while balancing potential treatment benefits and risks in each individual patient. The epidemiology of venous thromboembolism, the methods for achieving venous thromboembolism prophylaxis, and the approach to institute venous thromboembolism prophylaxis in surgical patients undergoing various operative interventions are reviewed in this article.     

Approach to venous thromboembolism prophylaxis: are we evolving fast enough in plastic surgery?

Venous thromboembolism has become a target for research by the American Society of Plastic Surgery. The current article reviews the steps that plastic surgeons and the American Society of Plastic Surgery have taken for creating guidelines in our field. We summarized the current reported incidences of venous thromboembolism in various plastic surgical procedures, and reviewed the current efforts that the society is taking to address the burden of this deadly preventable disease.     

Direct thrombin inhibitors for the treatment of venous thromboembolism: analysis of the Dabigatran versus Warfarin clinical trial

Vitamin-K antagonists have played a dominant role in the long-term management of patients with venous thromboembolism, and large trials from the past decade reinforced warfarin's effectiveness as an intermediate-duration and extended-duration anticoagulant. However, promising new oral direct thrombin inhibitors are proving to be at least as effective and as safe as the vitamin-K antagonists, without the associated hepatic toxicity that was seen with earlier orally administered direct thrombin inhibitors. This article reviews the recently published Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism clinical trial, and discusses the limitations and clinical applicability of the trial, especially in comparison with vitamin-K antagonists and the recently studied oral direct factor Xa inhibitors, rivaroxaban and apixaban.     

Thromboprophylaxis in trauma: a review of methods, evidence and guidelines

Venous thromboembolism is a common cause of morbidity and mortality in trauma patients. Mechanical and pharmacological methods of thromboprophylaxis are available and guidelines relating to thromboprophylaxis in trauma include those published by the American College of Chest Physicians, the UK-based National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network and US-based Eastern Association for the Surgery of Trauma. All four guidelines have in common a recommendation for the use of low-molecular-weight heparin except where contraindicated. However, there is little consensus between guidelines relating to which mechanical methods should be used. Given the risk of thromboembolism in trauma patients and increasing interest in this condition clinicians should be aware of local and national guidelines relating to venous thromboembolism prevention in trauma patients. This paper reviews methods of thromboprophylaxis and compares guidelines relating to their use in trauma patients.     

Venous thromboembolism: application and effectiveness of the American College of Chest Physicians 2001 guidelines for prophylaxis

CONTEXT: Guidelines on the use of prophylaxis in venous thromboembolism (VTE) are poorly implemented in clinical practice. OBJECTIVE: To evaluate the extent to which the American College of Chest Physicians (ACCP) 2001 guidelines on VTE prophylaxis are adhered to in clinical practice by determining whether patients admitted to a medical center with an objective diagnosis of VTE had received adequate prophylaxis. METHODS: The medical records of medical and surgery patients with an objective diagnosis of VTE were reviewed. Patients were classified as having either preventable or nonpreventable VTE according to indication for prophylaxis, VTE risk, and adequacy of prophylaxis if administered. Adequacy was determined by adherence to the ACCP 2001 guidelines. RESULTS: Of 44 patients, 17 (38.6%) had not received adequate prophylaxis and were classified as having potentially preventable VTE. Venous thromboembolism developed in the remaining 27 (61.4%) patients despite adequate prophylaxis. In general, adequate prophylaxis rates were lower among surgery patients compared with medical patients. Four (80%) of the very-high-risk surgery patients received inadequate prophylaxis. The most common VTE risk factor in both categories was immobility. CONCLUSIONS: Adherence to the ACCP guidelines is suboptimal, with a substantial proportion of patients with VTE receiving inadequate prophylaxis. The additional finding that the incidence of VTE is high despite adequate prophylaxis indicates that the guidelines may need to be reevaluated.     

Increased use of enoxaparin in pediatric trauma patients

PurposeVenous thromboembolism (VTE) in pediatric trauma patients has been reported from 0.7 to 4.2 patients per 1000 admissions. There are no clear guidelines for prophylactic anticoagulation in children. The purpose of this study was to examine the use of enoxaparin in pediatric trauma patients.MethodsThe Pediatric Health Information System database was queried from 2001 to 2008 for patients 0 to 18 years with a primary diagnosis of trauma based on International Classification of Diseases, Ninth Revision, codes. Patients who received enoxaparin and/or diagnosed with VTE were identified using pharmacy and International Classification of Diseases, Ninth Revision, codes. Logistic regression was used to identify patient and hospital characteristics associated with VTE and enoxaparin use.ResultsAmong 260,078 pediatric trauma patients, 3195 were prescribed enoxaparin (1.23%), 2915 (1.12%) of whom were given enoxaparin without a diagnosis of VTE. The incidence of VTE remained stable (0.23%-0.28%), whereas the use of enoxaparin increased (0.75%-1.54%), especially in patients without VTE (0.65%-1.43%). Venous thromboembolism was significantly associated with pelvic fractures, intensive care unit stay, and central venous catheters (P = .017, P < .001, P < .001).ConclusionsDespite a stable VTE incidence, the use of enoxaparin significantly increased in pediatric trauma patients, suggesting that use of pharmacologic thromboprophylaxis is increasing in pediatric trauma centers.