围手术期静脉血栓栓塞vte的防治ppt课件.ppt

Prevention and Treatment of Perioperative Venous Thromboembolism (VTE)
Gordon H. Guyatt, et al. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Suppl):7S–47S.
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Deep Venous Thrombosis
(DVT)
Pulmonary Embolism
(PE)
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VTE-related deaths
200,000 per year in US
1/3 occur following surgery
2~3-fold for cancer patients
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Prophylaxis?
VTE
Bleeding
VTE ↓71%
Death ↓46%
Major bleeding ↑103%
Wound hematoma ↑ 88%
Mismetti P, et al. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery .Br J Surg . 2001 ; 88 ( 7 ): 913 - 930 .
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Caprini Risk Assessment Model
1 Point
Age 41-60 y
Sepsis (< 1 mo)
Minor surgery
Varicose veins
BMI>25 kg/㎡
Swollen legs
Abnormal pulmonary function
Acute myocardial infarction
Serious lung disease, including pneumonia (< 1 mo)
Congestive heart failure (< 1 mo)
Pregnancy or postpartum
History of inflammatory bowel disease
History of unexplained or recurrent spontaneous abortion
Oral contraceptives or hormone replacement
Medical patient at bed rest
3 Points
Age ≥ 75 y
Lupus anticoagulant
History of VTE
Anticardiolipin
Antibodies
Family history of VTE
Elevated serum
Homocysteine
Factor V Leiden
Heparin-induced
thrombocytopenia
Prothrombin 20210A
Other congenital or
acquired thrombophilia
5 Points
Stroke (< 1 mo)
Elective arthroplasty
Hip, pelvis, or leg fracture
Acute spinal cord injury (< 1 mo)
2 Points
Age 61-74 y
Malignancy
Arthroscopic surgery
Confined to bed (> 72 h)
Major open surgery
(> 45 min)
Laparoscopic surgery
(> 45 min)
Immobilizing plaster cast
Central venous access
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Caprini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>25 kg/㎡
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