切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2017, Vol. 03 ›› Issue (03) : 151 -154. doi: 10.3877/cma.j.issn.2095-9141.2017.03.006

所属专题: 文献

临床研究

神经外科患者下肢静脉血栓的防治体会
马辉福1, 胡亚伟1,(), 韩光魁1, 张浩1, 杨冬旭1, 郭强1, 孔令胜1, 靳峰1   
  1. 1. 272029 济宁,济宁医学院附属医院神经外二科
  • 收稿日期:2017-02-19 出版日期:2017-06-15
  • 通信作者: 胡亚伟

Prevention and treatment of lower extremity venous thrombosis in Department of Neurosurgery

Huifu Ma1, Yawei Hu1,(), Guangkui Han1, Hao Zhang1, Dongxu Yang1, Qiang Guo1, Lingsheng Kong1, Feng Jin1   

  1. 1. Second Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2017-02-19 Published:2017-06-15
  • Corresponding author: Yawei Hu
  • About author:
    Corresponding author: Hu Yawei, Email:
引用本文:

马辉福, 胡亚伟, 韩光魁, 张浩, 杨冬旭, 郭强, 孔令胜, 靳峰. 神经外科患者下肢静脉血栓的防治体会[J]. 中华神经创伤外科电子杂志, 2017, 03(03): 151-154.

Huifu Ma, Yawei Hu, Guangkui Han, Hao Zhang, Dongxu Yang, Qiang Guo, Lingsheng Kong, Feng Jin. Prevention and treatment of lower extremity venous thrombosis in Department of Neurosurgery[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2017, 03(03): 151-154.

目的

探讨神经外科住院患者下肢静脉血栓症的防治策略。

方法

为了减少患者下肢静脉血栓形成,防止肺栓塞发生,本研究选取2016年4月至2016年10月济宁医学院附属医院神经外科收治的672例患者作为观察组,对所有患者分期风险评估,并进行早期机械和药物综合防治,观察总结患者临床资料、防治措施和疗效,并将防治策略调整前2015年10月至2016年3月住院的652例患者的相应资料作为对照组进行比较。

结果

观察组发生下肢静脉血栓35例(5.20%),肺栓塞2例(0.31%),对照组发生下肢静脉血栓59例(9.05%),无肺栓塞病例发生,观察组下肢静脉血栓和肺栓塞的发生率明显低于对照组,差异具有统计学意义(P<0.01)。

结论

神经外科疾病下肢静脉血栓的发生率高,医务人员应高度重视,早期机械预防和药物防治,可显著降低深静脉血栓和肺栓塞的风险,而且对血肿扩大和死亡率没有影响。

Objective

To explore the prevention and treatment strategy of venous thrombosis of lower extremity in hospitalized neurosurgery.

Methods

In order to reduce the incidence of venous thrombosis in the lower limbs and prevent the occurrence of pulmonary embolism, 672 inpatients treated in our hospital from April to October in 2016, were selected as the observation group. All patients were assessed for risk assessment and early mechanical and drug comprehensive prevention. The clinical data, control measures and curative effect of the patients were observed and compared with the data of 652 patients in the first 6 months after the improvement of the preventive measures as the control group.

Results

In the observation group, 35 patients had lower extremity venous thrombosis, the incidence rate was 5.20%, 2 cases of pulmonary embolism, the incidence rate was 0.31%; there were 59 patients with lower extremity venous thrombosis in the control group, the incidence rate was 9.05%, no cases of pulmonary embolism. The incidence of venous thrombosis and pulmonary embolism in the observation group was significantly lower than that in the control group (P<0.01).

Conclusion

The incidence of venous thrombosis in the lower limb of neurosurgical diseases is high. Medical personnel should attach great importance to it. Early mechanical prophylaxis and drug prevention can significantly reduce the risk of deep vein thrombosis and pulmonary embolism and have no effect on hematoma enlargement and mortality.

表1 2组患者下肢静脉血栓栓塞症统计(例)
[1]
Patel R, Cook DJ, Meade MO, et al. Burden of illness in venous thromboembolism in critical care: a multicenter observational study[J]. J Crit Care, 2005, 20(4): 341-347.
[2]
Attia J, Ray JG, Cook DJ, et al. Deep vein thrombosis and its prevention in critically ill adults[J]. Arch Intern Med, 2001, 161(10): 1268-1279.
[3]
White RH. The epidemiology of venous thromboembolism[J]. Circulation, 2003, 107(23 Suppl 1): I4-I8.
[4]
McRae S. Treatment options for venous thromboembolism: lessons learnt from clinical trials[J]. Thromb J, 2014, 12(1): 27.
[5]
Deitelzweig SB, Johnson BH, Lin J, et al. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections[J]. Am J Hematol, 2011, 86(2): 217-220.
[6]
Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality[J]. Thromb Haemost, 2007, 98(4): 756-764.
[7]
Simanek R, Vormittag R, Hassler M, et al. Venous thromboembolism and survival in patients with high-grade glioma[J]. Neuro Oncol, 2007, 9(2): 89-95.
[8]
Gearhart MM, Luchette FA, Proctor MC, et al. The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis[J]. Surgery, 2000, 128(4): 631-640.
[9]
Knudson MM, Ikossi DG, Khaw L, et al. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank[J]. Ann Surg, 2004, 240(3): 490-496.
[10]
Sharma OP, Oswanski MF, Joseph RJ, et al. Venous thromboembolism in trauma patients[J]. Am Surg, 2007, 73(11):1173-1180.
[11]
Macdonald PS, Kahn SR, Miller N, et al. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis[J]. J Vasc Surg, 2003, 37(3): 523-527.
[12]
Goldhaber SZ. Evolving concepts in thrombolytic therapy for pulmonary embolism[J]. Chest, 1992, 101(4 Suppl): 183S-185S.
[13]
Jeyabalan G, Saba S, Baril DT. Bradyarrhythmias durin grheolytic pharmacomechanical thrombectomy for deep vein thrombosis[J]. J Endovasc Ther, 2010, 17(3): 416-422.
[14]
Nathens AB, McMurray MK, Cuschieri J, et al. The practice of venous thromboembolism prophylaxis in the major trauma patient[J]. J Trauma, 2007, 62(3): 557-562.
[15]
Reiff DA, Haricharan RN, Bullington NM, et al. Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis[J]. J Trauma, 2009, 66(5): 1436-1440.
[16]
Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition)[J]. Chest, 2008, 133(6 Suppl): 381S-453S.
[17]
Rogers FB, Cipolle MD, Velmahos G, et al. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group[J]. J Trauma, 2002, 53(1):142-164.
[18]
Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy[J]. J Neurotrauma, 2007, 24(Suppl 1): S14-S20.
[19]
Paciaroni M, Agnelli G, Venti M, et al. Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies[J]. J ThrombHaemost, 2011, 9(5): 893-898.
[20]
Boeer A, Voth E, Henze T, et al. Early heparin therapy in patients with spontaneous intracerebral haemorrhage[J]. J Neurol Neurosurg Psychiatry, 1991, 54(5): 466-467.
[21]
Orken DN, Kenangil G, Ozkurt H, et al. Prevention of deep venous thrombosis and pulmonary embolism in patients with acute intracerebral hemorrhage[J]. Neurologist, 2009, 15(6): 329-331.
[22]
Tetri S, Hakala J, Juvela S, et al. Safety of low-dose subcutaneous enoxaparin for the prevention of venous thromboembolism after primary intracerebral haemorrhage[J]. Thromb Res, 2008, 123(2):206-212.
[23]
Wasay M, Khan S, Zaki KS, et al. A non-randomized study of safety and efficacy of heparin for DVT prophylaxis in intracerebral haemorrhage[J]. J Pak Med Assoc, 2008, 58(7): 362-364.
[24]
Lansberg MG, O’Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2012, 141(2 Suppl): e601S-e636S.
[25]
Dickmann U, Voth E, Schicha H, et al. Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage[J]. Klin Wochenschr, 1988, 66(23): 1182-1183.
[1] 李飞翔, 段虎斌, 李晋虎, 吴昊, 王永红, 范益民. 急性颅脑损伤继发下肢静脉血栓的相关危险因素分析及预测模型构建[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 277-282.
[2] 许琳惠, 任建庄, 段旭华, 张文广, 陈鹏飞, 李亚华, 王家兴, 万里, 邝东林, 韩新巍. 腹主动脉假性动脉瘤致下肢深静脉血栓形成介入治疗一例[J]. 中华介入放射学电子杂志, 2020, 08(03): 285-287.
阅读次数
全文


摘要