摘要
目的:探讨脊柱外科术后血栓栓塞分层预防方法的有效性和安全性。方法:选取2008年6月至2009年6月北京大学第一医院骨科的脊柱常规手术患者共298例,按其不同危险因素分为低、中、高危组预防手术后静脉血栓栓塞并发症,3组患者分别为22例、48例和228例。低、中危组患者主要采取物理预防措施,包括分级加压弹力袜(thigh-length thromboembolic deterrent stockings,TEDS)和间歇充气加压装置(pneumatic sequential compressiondevice,PSCD);对于高危组患者,除了采用物理预防措施,还应用了低分子肝素钙肌注。于术前、术后7～10 d及术后3个月行下肢血管多普勒超声检查评价患者有无深静脉血栓形成,同时监测是否发生硬膜外或伤口血肿、黏膜出血,是否发生低分子肝素致血小板减少,是否有硬膜外出血致神经损伤症状等。结果:298例脊柱常规手术患者,发生深静脉血栓(deep vein thrombosis,DVT)23例,发生率7.7%。低危组患者均未发生DVT,中危组患者发生DVT 2例(4.2%),高危组患者发生DVT 21例(9.2%)。所有患者均未发生肺栓塞(pulmonary embolism,PE)。所有DVT均为小腿肌间静脉血栓,位于膝关节以远,无临床症状,不需治疗,术后3个月复查多普勒超声时血管再通。所有患者均未发生低分子肝素所致硬膜外或伤口血肿、黏膜出血等出血并发症,未出现硬膜外出血所致神经损伤症状,未发现低分子肝素致血小板减少的发生。结论:对脊柱术后静脉血栓栓塞症(venous thrombus embolism,VTE)进行危险分层,根据分层做个体化预防后,未发生临床意义的血栓栓塞,未发生要预防的并发症,因而初步验证该预防方法较为安全、有效,今后需要进行前瞻性病例对照研究进一步评价其安全性和有效性。
Objective： To investigate the efficacy and safety of venous thrombus embolism（VTE） prophylaxis according to risk stratifications after spinal surgery.Methods： From June 2008 to June 2009,we separated 298 spinal patients who had different VTE risk factors into low-,medium-and high-risk groups for 22 cases,48 cases and 228 cases respectively.Physical prevention measures such as thigh-length thromboembolic deterrent stockings（TEDS） and pneumatic sequential compression device（PSCD） were used in low-and medium-risk groups.In high-risk groups,low molecular weight heparin（LMWH） was applied in addition to physical prevention measures.Lower limb vascular doppler ultrasonography was used to monitor thrombosis pre-and postoperatively.Simultaneously the occurrences of epidural or wound hematoma,mucosal bleeding,thrombocytopenia caused by low molecular heparin and nerve damage caused by extradural hemorrhage were monitored.Results： Among the 298 cases of patients with spinal surgery,DVT occurred in 23 cases,the incidence of DVT was 7.7%.There were 0,2 and 21 patients with positive fin-dings of deep vein thrombosis on duplex ultrasonograph respectively in low-,medium-and high-risk groups.There was no case of PE.All DVT was thrombosis in calf which was distal to the knee.There was no clinical symptom of VTE.The DVT needed no therapy.The vein with thrombosis was recanalized 3 months after operation.No case caught epidural or wound hematoma,mucosal bleeding,thrombocytopenia caused by low molecular heparin or nerve damage caused by extradural hemorrhage.Conclusion： Individual VTE prophylaxis was taken according to risk stratifications.No VTE of clinical value or no complications from prophylaxis happened.So our prophylaxis is effective and safe.But more prospective,case-control studies are needed to assess the efficacy and safety of VTE prophylaxis.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期661-665,共5页
Journal of Peking University:Health Sciences
基金
北京大学第一医院青年基金资助~~
关键词
脊柱疾病
静脉血栓形成
血栓栓塞
Spinal diseases
Venous thrombosis
Thromboembolism
