摘要
目的评估湖南某三甲医院骨科在人工关节置换术后深静脉血栓(deep venous thrombosis,DVT)预防的现状和预防后DVT的发生情况。方法选择2012年6月～2012年10月中南大学湘雅医院接受人工关节置换患者100例,记录入选患者人口学和病史资料、手术资料、术后DVT预防情况等。入选患者统一于术后7～10 d行双侧下肢深静脉彩超检查,术后28 d行电话随访,记录死亡和大出血事件。结果所有患者均进行了基本预防措施、物理预防措施和药物预防措施相结合的联合预防。其中35例患者术后首次口服利伐沙班时间迟于美国胸科医生协会发表的《抗栓与溶栓治疗询证指南》第8版(ACCP-8)推荐的术后10 h。采取预防措施后有2例患者彩超发现无症状性下肢DVT,未见肺栓塞病例,术后28 d随访未出现死亡和大出血事件的发生。结论该医院骨科人工关节置换术后DVT预防措施与指南符合率高,但首次给药时间应更加及时与准确。术后彩超结果显示,规范的预防措施能够降低DVT的发生率,但不能杜绝其发生。
Objective To evaluate the status of deep vein thrombosis （DVT） prophylaxis and the incidence of the DVT after prophylaxis in patients with artificial joint replacement in a tertiary hospital in Hu＇nan. Methods 100 patients with artificial joint replacement in Xiangya Hospital of Central South University from June 2012 to October 2012 were enrolled, the demographic data and medical history, surgical materials, and DVT prophylaxis status were recorded. All patients were examined by color Doppler ultrasound 7-10 days postoperatively, and a follow-up of death and massive bleeding were performed on the 28th day after the operation. Results The combination prophylaxis was applied to all the patients, including the basic, physical and drug prophylaxis. In 35 cases out of 100, Rivaroxaban was given later than I0 h postoperatively, inconsistent with ACCP-8 recommendations （Antithrombotic and Thrombolytic Therapy： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines）. 2 patients receiving prophylaxis were diagnosed with asymptomatic DVT by color Doppler ultrasound. No pulmonary embolism was found in any case. No death report or massive bleeding was found in the postoperative follow-up. Conclusion The accordance of the DVT prophylaxis after artificial joint replacement with the ACCP-8 guidelines is high in this tertiary hospital. However, the patients should take the first dose of Rivaroxaban timely and accurately. The results of color Doppler ultrasound show that incidence of DVT can be reduced but not eliminated by the prophylaxis.
出处
《中国医药导报》
CAS
2013年第9期46-48,共3页
China Medical Herald
关键词
人工关节置换术
DVT预防
彩超
前瞻性
Artificial joint replacement
DVT prophylaxis
Color Doppler ultrasound
Prospective
