围手术期静脉血栓栓塞VTE的防治.pptx

该【围手术期静脉血栓栓塞VTE的防治 】是由【业精于勤】上传分享，beplayapp体育下载一共【28】页，该beplayapp体育下载可以免费在线阅读，需要了解更多关于【围手术期静脉血栓栓塞VTE的防治 】的内容，可以使用beplayapp体育下载的站内搜索功能，选择自己适合的beplayapp体育下载，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此beplayapp体育下载到您的设备，方便您编辑和打印。PreventionandTreatmentofPerioperativeVenousThromboembolism(VTE)
,,9thed:AmericanCollegeofChestPhysiciansEvidence-;141(2)(Suppl):7S–47S.
第1页
DeepVenousThrombosis
(DVT)
PulmonaryEmbolism
(PE)
第2页
VTE-relateddeaths
200,000peryearinUS
1/3occurfollowingsurgery
2~3-foldforcancerpatients
第3页
Prophylaxis?
VTE
Bleeding
VTE↓71%
Death↓46%
Majorbleeding↑103%
Woundhematoma↑88%
MismettiP,-.;88(7):913-930.
第4页
CapriniRiskAssessmentModel
1Point
Age41-60y
Sepsis(<1mo)
Minorsurgery
Varicoseveins
BMI>25kg/㎡
Swollenlegs
Abnormalpulmonaryfunction
Acutemyocardialinfarction
Seriouslungdisease,includingpneumonia(<1mo)
Congestiveheartfailure(<1mo)
Pregnancyorpostpartum
Historyofinflammatoryboweldisease
Historyofunexplainedorrecurrentspontaneousabortion
Oralcontraceptivesorhormonereplacement
Medicalpatientatbedrest
3Points
Age≥75y
Lupusanticoagulant
HistoryofVTE
Anticardiolipin
Antibodies
FamilyhistoryofVTE
Elevatedserum
Homocysteine
FactorVLeiden
Heparin-induced
thrombocytopenia
Prothrombin0A
Othercongenitalor
acquiredthrombophilia
5Points
Stroke(<1mo)
Electivearthroplasty
Hip,pelvis,orlegfracture
Acutespinalcordinjury(<1mo)
2Points
Age61-74y
Malignancy
Arthroscopicsurgery
Confinedtobed(>72h)
Majoropensurgery
(>45min)
Laparoscopicsurgery
(>45min)
Immobilizingplastercast
Centralvenousaccess
第5页
Caprini风险评分
危险原因得分:1分
年纪41-60岁
败血症(1个月内)
小手术
静脉曲张
BMI>25kg/㎡
肺功效异常
下肢水肿
急性心肌梗塞
严重肺部疾病,包含肺炎(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换治疗
需要卧床休息患者
危险原因得分:3分
年纪≥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
肝素诱导血小板降低症
凝血酶原0A阳性
其它先天性或取得性血栓症
危险原因得分: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)
危险原因得分:2分
年纪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
第6页
VTERisk ForGeneralSurgery
IncludingGI,Urological,Vascular,Breast,andThyroidProcedures
VTERisk
CapriniScore
ObservedRiskofSymptomaticVTE,%
Verylow
0
0
Low
1-2

Moderate
3-4

High
≥5

第7页
RiskFactorsforMajorBleedingComplications
Generalriskfactors 
Activebleeding 
Previousmajorbleeding 
Known,untreatedbleedingdisorder 
Severerenalorhepaticfailure 
Thrombocytopenia 
Acutestroke 
Uncontrolledsystemichypertension 
Lumbarpuncture,epidural,orspinalanesthesiawithinprevious4hornext12h 
Concomitantuseofanticoagulants,antiplatelettherapy,orthrombolyticdrugs
第8页
RiskFactorsforMajorBleedingComplications
Procedure-specificriskfactors 
Abdominalsurgery 
Malesex,preoperativehemoglobinlevel<13g/dL,malignancy,andcomplexsurgerydefinedastwoormoreprocedures,difficultdissection,ormorethanoneanastamosis 
Pancreaticoduodenectomy 
Sepsis,pancreaticleak,sentinelbleed 
Hepaticresection 
Numberofsegments,concomitantextrahepaticorganresection,primarylivermalignancy,lowerpreoperativehemoglobinlevel,andplateletcounts
第9页
RiskFactorsforMajorBleedingComplications
Procedure-specificriskfactors 
Cardiacsurgery 
Useofaspirin 
Useofclopidogrelwithin3dbeforesurgery 
BMI>25kg/m2,nonelectivesurgery,placementoffiveormoregrafts,olderage 
Olderage,renalinsufficiency,operationotherthanCABG,longerbypasstime 
Thoracicsurgery 
Pneumonectomyorextendedresection
第10页