妇科恶性肿瘤围术期静脉血栓栓塞症的高危因素研究及对策

目的 分析妇科恶性肿瘤住院手术治疗患者的围术期静脉血栓栓塞症（VTE）发生的高危因素。方法 纳入本市电子病历系统登记的初次手术治疗的妇科恶性肿瘤患者共2364例,根据围术期是否发生VTE分为[VTE（+）组,110例],其他纳入对照组[VTE（-）组,2254例]。分析发生VTE的高危因素。结果 妇科恶性肿瘤患者围术期VTE发生的高危因素包括年龄≥57.5岁、合并高血压、合并糖尿病、开腹手术、病理类型为子宫内膜癌。结论 妇科恶性肿瘤手术患者围术期VTE的发生受多种因素影响,在诊疗过程中应对患者进行评估并对具有高危因素患者采取预防措施,以减少围术期VTE发生,促进患者康复。     

口服抗凝剂的妇科手术患者围手术期管理

口服抗凝剂可造成妇女的月经量增多及凝血系统发生改变,加之妇科患者及妇科手术独有的特点,妇科手术患者围手术期抗凝管理是个重要的临床难题。口服抗凝剂的患者如进行手术,将面临着出血及血栓形成的风险,医生既要考虑手术前后可能出现的出血情况,又要避免因暂时停用抗凝药物而发生血栓栓塞的危险,此类患者手术成功的关键是抗凝剂的使用情况及手术时间的选择。因此,妇科手术患者的术前评估及术中、术后管理具有重要的临床意义。综述低分子肝素作为桥梁的围手术抗凝方法在妇科临床工作中的应用。     

冠心病及心律失常的围手术期处理

冠状动脉粥样硬化性心脏病,指冠状动脉粥样硬化使血管胜阻塞导致心肌缺血缺氧而引起的心脏病,简称冠心病。该病多见于40岁以上的中老年人,女性于绝经后发病率明显上升。近年来,由于手术和麻醉方法的不断改进,以及社会面临老龄化,冠。已病病人进行非心脏手术机会明显增多。据统计,围手术期死亡病例中50％死于。心血管并发症,这其中半数以上是由于心肌缺血所致。因此,冠心病患者围手术期的处理显得特别重要,并需要;动内科和麻醉科医师协同妇产科医师一起处理。l术前处理1．l患者围手术期危险性的评估冠。心病轻者可表现为无症状的…     

浅谈妇产科围手术期患者的护理

目的:讨论妇产科围手术期患者的护理。方法:配合手术治疗进行护理。结论:妇产科围手术期护理重点是通过全面评估,充分做好术前准备、提高手术安全性、减少术后并发症等方面,以加强对妇产科护理对象的身心护理,促进其能够早日康复。     

妇科疾病合并系统性红斑狼疮的围手术期管理

系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种表现为多系统损害的慢性系统性自身免疫病,经常继发心、肺、肾等多脏器功能障碍,不能耐受围手术期应激及手术创伤,导致病情进展,甚至出现严重围手术期并发症。手术是妇科疾病尤其是妇科肿瘤的重要治疗手段,SLE患者的妇科围手术期管理是非常棘手的临床问题。本文从术前评估、围手术期用药、术中及术后的处理等方面综合,论述围手术期系统性红斑狼疮患者行妇科手术的处理。     

糖尿病患者妇科手术围手术期处理要点

糖尿病是以高血糖为主要特点,引起代谢紊乱综合征的一种疾病。糖尿病患者对手术耐受性差,手术应激、麻醉、术后疼痛等均增加其手术复杂性及危险性。做好糖尿病患者围手术期管理是手术成功以及减少并发症的重要因素,应当把需要接受手术治疗的糖尿病患者视为高危和疑难病例进行全面系统的围手术期综合管理,重点包括：健康教育、饮食调节、血糖控制、心血管事件和感染预防等。     

口服抗凝剂的妇科手术患者围手术期管理

口服抗凝剂可造成妇女的月经量增多及凝血系统发生改变,加之妇科患者及妇科手术独有的特点,妇科手术患者围手术期抗凝管理是个重要的临床难题.口服抗凝剂的患者如进行手术,将面临着出血及血栓形成的风险,医生既要考虑手术前后可能出现的出血情况,又要避免因暂时停用抗凝药物而发生血栓栓塞的危险,此类患者手术成功的关键是抗凝剂的使用情况...     

围手术期患者的护理体会

现代社会人民平均寿命延长至七十九岁,但是冠心病在我国的发病率却仍然是我国患者死亡率最高的疾病之一。外科手术治疗的冠心病病人也很多。由于受麻醉,手术创伤和其它因素的影响,冠心病患者在围手术期可发生急性心肌缺血,或者心律失常等意外。因此,手术前及手术后的护理非常重要。     

多元化妇科手术快速发展背景下围手术期处理的思索

妇科手术方式在最近几十年已经发生了革命性的变化,从传统的手术方式已经逐步转向微创手术或内镜手术,手术方式的改变导致了许多新并发症的出现,对围手术期的处理提出了新的挑战。同时随着医学科学与相关专业技术的发展,手术适应证逐渐扩大,高危手术患者也在逐年增加, 这些客观上都要求手术医师努力提高围手术期的处理能力,重视与患者和家属的沟通,培养人文关怀的精神。     

妇科恶性肿瘤手术围手术期特殊管理

手术是多数妇科恶性肿瘤主要的治疗手段之一,根据妇科恶性肿瘤病变和手术治疗的特点,围手术期管理的重点是准确评估、在规范化的前提下选择个体化手术方案和防治特殊手术并发症,以保障手术安全、降低手术并发症、减少手术对女性生理和心理的创伤、改善患者预后。     

Venous Thromboembolism in Minimally Invasive Gynecologic Surgery: A Systematic Review

Venous thromboembolism (VTE) is the leading cause of preventable healthcare-related death after surgery. Although there is a large body of research on VTE in the general population as well as risk-assessment tools, evidence specific to the current practices in gynecologic surgery is more sparse. This review article seeks to discuss current literature on VTE in gynecologic surgery, with a focus on minimally invasive surgery. Evidence on risk factors for VTE in gynecologic surgery is evaluated as well as current recommendations use of thromboprophylaxis for prevention of VTE. Despite data showing that minimally invasive gynecologic surgery independently decreases risk of VTE compared with laparotomy, current clinical risk assessment tools and guidelines do not incorporate mode of surgery into recommendations for perioperative VTE prevention.     

妇产科静脉血栓栓塞症发生的高危因素

静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE）,是妇产科常见的严重并发症,其发展迅速,病死率高。VTE重在风险评估和疾病预防,文章就国内外相关文献,结合自身经验总结妇产科临床常见的VTE高危因素及其潜在机制。     

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM (VTE) IN OBSTETRICS

OBJECTIVE: to identify risk factors for venous thromboembolism (VTE) in the peripartum period and to provide guidelines for risk assessment and thromboprophylactic measures for VTE in pregnant women. Guidelines for diagnostic testing and for acute and long term treatment of VTE are also provided.OPTIONS: specific subgroups of pregnant women are defined and appropriate prophylactic measures are outlined. OUTCOMES: venous thromboembolism remains a major cause of morbidity and mortality in pregnancy and the postpartum period. Identification of risk and adequate prophylaxis can decrease the incidence of VTE.EVIDENCE: evidence was gathered using Medline (National Library of Medicine) to identify relevant studies and from bibliographies of articles thus identified.RECOMMENDATIONS: although evidence is lacking to date from Grade I studies (properly controlled randomized studies) in pregnant patients, there is good evidence to support the role of prophylaxis in reducing the incidence of VTE in patients identified to be at risk in the non-pregnant population (II B). Based on risk assessment more patients should be considered for thromboprophylaxis, including women with a past history of a VTE and a known thrombophilia on long-term anticoagulation, women with a past history of a VTE, women with a known thrombophilia who have never experienced a VTE and potentially considered in women at the time of Caesarean section (II B; III C). The occurrence of VTE is effectively reduced by the use of low dose unfractionated heparin. Experience with low molecular weight heparin and pregnancy is building, but is limited at present. Unfractionated heparin remains the standard for the treatment of VTE in pregnancy at the present time. Following initial heparinization for the treatment of VTE, patients should be continued on anticoagulation throughout pregnancy and for six to 12 weeks postpartum or a total of three months of anticoagulation (II A).     

The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case–control study using the General Practice Research Database

Objective  To assess whether use of tranexamic acid is associated with an increased risk of venous thromboembolism (VTE).
Design  Nested case–control study.
Setting  Database study using the General Practice Research Database for the years 1992–1998.
Population  Women aged 15–49 years with a diagnosis of menorrhagia.
Methods  Multivariate conditional logistic regression was used to estimate the risk for VTE associated with different drug treatments for menorrhagia, adjusting for confounders.
Main outcome measures  Adjusted odds ratios with 95% CI.
Results  A total of 134 cases of VTE and 552 matched controls were identified. Recent use of tranexamic acid was scarce, yielding an adjusted odds ratio for VTE of 3.20 (95% CI 0.65–15.78). The use of mefenamic acid (OR_adj 5.54 [95% CI 2.13–14.40]) or norethisterone (OR_adj 2.41 [95% CI 1.00–5.78]) was associated with an increased risk of VTE, as was a recent—in relation to menorrhagia—diagnosis of anaemia or a haemoglobin value <11.5 g/dl (OR_adj 2.23 [95% CI 1.02–4.86]).
Conclusions  We found that tranexamic acid was associated with an increased risk of VTE, although the risk estimate did not reach statistical significance. Increased risks of VTE associated with other treatments for menorrhagia were observed. The increased risk of VTE observed with a diagnosis of anaemia—a proxy for more severe menorrhagia—suggests that menorrhagia could be a prothrombotic condition. The observed association between VTE, tranexamic acid and other treatments for menorrhagia may thus partly be explained by confounding by indication. The possibility that menorrhagia is itself a risk factor for VTE merits further investigation.     

Can changes in sex hormone binding globulin predict the risk of venous thromboembolism with combined oral contraceptive pills?

BACKGROUND: Recent studies have indicated that the risk of thromboembolic disease (VTE) in users of combined oral contraceptive pills (COCs) varies not only with estrogen dose, but also with the progestogen in pills with the same estrogen dose. The aim of this article is to discuss sex hormone binding globulin (SHBG) as a marker of estrogenicity and as a surrogate indicator for the potential risk of VTE in users of COC. MATERIAL AND METHODS: Using data from the literature, we investigated the relationship between the risk of VTE with various COCs and their effects on SHBG. We also collected data on the effects on SHBG by some combined preparations, where there are no VTE data. RESULTS: There appears to be a relationship between the risk of VTE and the effect on SHBG. Monophasic preparations containing levonorgestrel, having the lowest risk of VTE, cause an average SHBG increase of around 50%. COCs containing desogestrel or gestodene cause an average SHBG increase of 200-300%. A preparation with cyproterone acetate, carrying a higher risk of VTE than desogestrel and gestodene, cause a 300-400% SHBG increase. With the recently developed combined preparations, there is a 150% SHBG increase with norgestimate and a 250-300% increase with drosperinone and dienogest. CONCLUSIONS: We propose that the change in SHBG with a COC could be interpreted as a measure of total estrogenicity and used as a predictor of the risk of VTE. Preparations containing drosperinone, dienogest, cyproterone acetate and norgestimate are equally or more estrogenic than the more thoroughly studied COCs, containing desogestrel or gestodene and should not be considered a safer substitute.     

妊娠合并复发性下肢静脉血栓伴家族性血栓病史一例并文献复习

分析吉林大学第二医院收治的1例妊娠合并复发性下肢静脉血栓伴家族性血栓病史病例的临床资料,并回顾分析既往相关文献及资料。妊娠妇女发生下肢静脉血栓栓塞症(VTE)风险是非妊娠妇女的5倍左右,既往下肢VTE史、家族性血栓病史均是VTE的高危因素。本例患者既往产褥期下肢静脉血栓溶栓治疗后再次复发,此次给予抗凝治疗后未出现不良后果。对于VTE高危型孕产妇,适当的抗凝治疗利大于弊,产褥期格外需要重视。如今剖宫产率的增加更提高了术后VTE发生的风险,因此产前的评估、产后的严密观察以及适当的抗凝治疗可以降低妊娠相关的复发性VTE发生率。     

Contraception-Related Venous Thromboembolism in a Pediatric Institution

Study ObjectiveTo define the thrombotic risk factors of young women presenting to a children's hospital with hormonal contraception-related venous thromboembolism (VTE). We hypothesized that the majority of patients would have additional risk factors for VTE.DesignClinical and laboratory data obtained retrospectively from electronic medical records concerning history of presentation, body mass index (BMI), medical and family history, medication profile, and relevant laboratory studies.SettingNationwide Children's Hospital in Columbus, Ohio, November 2008-May 2012.ParticipantsTwenty-six female patients, age 12-21 years, admitted for hormonal contraception-related VTE.ResultsFifty-seven VTE cases were reviewed, and 26 were identified as contraception-related VTE. 96% of patients had at least 1 additional risk factor for VTE, and 42% of patients had 2 or more additional risk factors. 50% patients had a BMI ≥25 kg/m². 35% of patients had a positive family history of VTE in a first or second-degree relative. 27% of patients were subsequently diagnosed with an inherited thrombophilia, 5 of whom had a positive family history.ConclusionIn a small population of adolescents presenting to a children's hospital with contraception-related VTE, the majority of patients had multiple risk factors for VTE. Obesity was the most common additional risk factor (50%) identified in our study population. More research is needed regarding the impact of obesity on contraception-related VTE in young women, and whether the presence of obesity should influence thrombophilia screening practices prior to prescribing contraception.     

Can we identify risk factors during pregnancy for thrombo-embolic events during the puerperium and later in life?

Objectives: To investigate parturients at risk to develop venous thrombo-embolic events (VTE) in the puerperium or later in life, during a follow-up of more than a decade and compare risk factors for VTE during the puerperium with VTE later in life.

Methods: A nested case–control study was conducted to profile parturients at risk for VTE and a secondary analysis to compare risk factors for VTE during or after puerperium. We used a cohort of 95?257 women who gave birth between the years 1988 and 1998.

Results: Independent risk factors to develop VTE were peripartum hysterectomy, stillbirth, cesarean delivery (CD), obesity, pregnancy-related hypertension, grandmultiparity and advanced maternal age. Women undergoing CD and those receiving blood transfusion were more likely to develop early versus late VTE (OR?=?2.0, 95% CI?=?1.15–3.5 and OR?=?11.0, 95% CI?=?2.25–55.5; respectively). Patients that encountered VTE during the puerperium had more pulmonary emboli and less deep vein thrombosis, compared with the late VTE group (p?Conclusions: Maternal age, grandmultiparity, pregnancy-related hypertension, CD, obesity, stillbirth and peripartum hysterectomy are independent risk factors for the development of VTE. CD and blood transfusion were predictive of early versus late VTE.