围手术期静脉血栓栓塞(VTE)的防治.ppt

PreventionandTreatmentofPerioperativeVenousThromboembolism(VTE),,9thed:AmericanCollegeofChestPhysiciansEvidence-;141(2)(Suppl):7S–(DVT)PulmonaryEmbolism(PE)VTE-relateddeaths200,000peryearinUS1/urfollowingsurgery2~3-foldforcancerpatientsProphylaxis?VTEBleedingVTE↓71%Death↓46%Majorbleeding↑103%Woundhematoma↑88%MismettiP,-;88(7):913--60ySepsis(<1mo)MinorsurgeryVaricoseveinsBMI>25kg/㎡SwollenlegsAbnormalpulmonaryfunctionAcutemyocardialinfarctionSeriouslungdisease,includingpneumonia(<1mo)Congestiveheartfailure(<1mo)PregnancyorpostpartumHistoryofinflammatoryboweldiseaseHistoryofunexplainedorrecurrentspontaneousabortionOralcontraceptivesorhormonereplacementMedicalpatientatbedrest3PointsAge≥75yLupusanticoagulantHistoryofVTEAnticardiolipinAntibodiesFamilyhistoryofVTEElevatedserumHomocysteineFactorVLeidenHeparin-inducedthrombocytopeniaProthrombin20210AOthercongenitaloracquiredthrombophilia5PointsStroke(<1mo)ElectivearthroplastyHip,pelvis,orlegfractureAcutespinalcordinjury(<1mo)2PointsAge61-74yMalignancyArthroscopicsurgeryConfinedtobed(>72h)Majoropensurgery(>45min)Laparoscopicsurgery(>45min)essCaprini风险评分危险因素得分:1分年龄41-60岁败血症(1个月内)小手术静脉曲张BMI>25kg/㎡肺功能异常下肢水肿急性心肌梗塞严重肺部疾病,包括肺炎(1个月内)充血性心力衰竭(1个月内)妊娠期或产后肠炎病史不能解释或二次自然流产病史口服避孕药或激素替代治疗需要卧床休息的患者危险因素得分:3分年龄≥75岁狼疮抗凝物阳性VTE病史抗心磷脂抗体阳性VTE家族史血清同型半胱氨酸升高因子VLeiden阳性肝素诱导的血小板减少症凝血酶原20210A阳性其他先天性或获得性血栓症危险因素得分:5分脑卒中(1个月内)髋关节、骨盆或下肢骨折择期关节置换术急性脊柱损伤(1个月内)危险因素得分:2分年龄61-74岁恶性肿瘤关节镜手术卧床(>72h)开放式手术(>45min)石膏固定腹腔镜手术(>45min)中央静脉通路VTERisk ForGeneralSurgeryIncludingGI,Urological,Vascular,Breast,andThyroidProceduresVTERiskCapriniScoreObservedRiskofSymptomaticVTE,%Verylow00Low1--≥plicationsGeneralriskfactors Activebleeding Previousmajorbleeding Known,