1、腰椎滑脱术后第腰椎滑脱术后第7 7天天肺栓塞死亡肺栓塞死亡 Total hip replacement,THRTotal knee replacement,TKRHip fractures surgery,HFSSpine S脊柱手术后脊柱手术后脊柱手术后脊柱手术后VTEVTEVTEVTE的风险与预防的风险与预防的风险与预防的风险与预防济南军区总医院 骨病科1.1.脊柱手术后脊柱手术后VTE的发生率是多少？的发生率是多少？2.2.预防措施有那些？是否有效？预防措施有那些？是否有效？3.3.药物预防存在什么风险？药物预防存在什么风险？1.1.Overall rate of VTE after s
2、pinal surgery Overall rate of VTE after spinal surgeryCheng JS,Arnold PM,Anderson PA,et al.Anticoagulation risk in spine surgery.Spine,2010,20;35(9 Suppl):S117-S124.15StudiesOverall rate of DVT is 2.6%(69/2627)DVTOverall rate of PE is 0.69%(18/2627)PEOverall rate of Fatal PE is 0.08%(2/2627)Fatal PE
3、2.2.Mechanical prophylaxisMechanical prophylaxisRokito 329 patients0.3%(1/329)Rokito SE,Schwartz MC,Neuwirth MG.Deep vein thrombosis after major reconstructive spinal surgery.Spine,1996,1(7):853-858.Wood 136 patients1.5%(2/136)Wood KB,Kos PB,Abnet JK,et al.Prevention of deep-vein thrombosis after ma
4、jor spinal surgery:a comparison study of external devices.J Spinal Disord.1997,10(3):209-214.DVT ChemoprophylaxisChemoprophylaxisCheng JS,Arnold PM,Anderson PA,et al.Anticoagulation risk in spine surgery.Spine,2010,20;35(9 Suppl):S117-S124.0.33%(9/2732)0.21%(6/2732)LMWH Cheng JS,Arnold PM,Anderson P
5、A,et al.Anticoagulation risk in spine surgery.Spine,2010,20;35(9 Suppl):S117-S124.3.The risk of 3.The risk of chemoprophylaxischemoprophylaxisLMWH 5.12%(26/508)0.81%(20/2462)0.39%(10/2507)A 56-year-old patient who had underwent a posterior cervical laminectomy and fusion for cervical spondylitic mye
6、lopathy Cheng JS,Arnold PM,Anderson PA,et al.Anticoagulation risk in spine surgery.Spine,2010,20;35(9 Suppl):S117-S124.Mechanical compression devices in the lower extremities are suggested.Initiation of mechanical compression just prior to or at the beginning of surgery and continuation until the pa
7、tient is fully ambulatory is a reasonable practice.Chemoprophylaxis may not be warranted in most common elective spine surgeries.LMWH may be used after surgery after elective combined anterior-posterior spine surgery or in patients identified as having a high risk for VTE,such as multiple trauma,mal
8、ignancy,or hypercoagulable state.For patients with additional risk factors such as advanced age,malignancy,presence of neurologic deficit,previous thromboembolism,or an anterior surgical approach.Any of the following prophylaxis options are recommended:(1)postoperative low dose unfractionated hepari
9、n(LDUH)alone(2)postoperative LMWH alone(3)perioperative intermittent pneumatic compression(IPC)alone.“不为良相，愿为良医不为良相，愿为良医”北宋北宋 范仲淹范仲淹“Either to be a good prime minister or to be an excellent doctor”The Lancet,Volume 376,Issue 9742,Page 657,28 August 2010“病人以性命相托，我们怎能不诚惶诚恐，如临病人以性命相托，我们怎能不诚惶诚恐，如临深渊，如履薄冰深渊，如履薄冰”医学泰斗，湘雅精神缔造者医学泰斗，湘雅精神缔造者张孝骞张孝骞
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