摘要
目的:探讨脊柱手术后静脉血栓栓塞(VTE)的风险及预防性应用低分子量肝素的有效性和安全性。方法:2005年8月～2006年7月由同一组术者施行脊柱手术的患者共156例,其中2005年8月～2005年12月共62例(第1组),2006年1月～2006年7月共94例(第2组),第2组中VTE高危者62例、VTE低危者32例,第1组及第2组中的VTE低危组患者术后未予低分子量肝素预防血栓治疗,第2组中的VTE高危组患者于术后第1天开始应用低分子量肝素(诺易平)抗凝治疗,0.25ml/次,皮下注射,2次/日,至下地活动后2d停用(共用药5～21d,平均8d)。观察第1、2组患者术后VTE的发生率及第2组患者切口引流量、消化道等粘膜出血情况、硬膜外和伤口血肿情况、有无神经损伤症状。结果:第1组患者术后VTE发生率为3.2%(2/62),其中1例术后第7天彩色多普勒超声检查发现下肢深静脉血栓形成,但无症状;另1例术后5d急性肺栓塞猝死。第2组患者术后未发生VTE,其中血栓高危组和低危组患者术后切口引流量的差异无统计学意义(P>0.05),均无粘膜出血、硬膜外及切口血肿,无神经损伤症状。结论:脊柱手术后有下肢深静脉血栓形成甚至发生肺栓塞的风险,对有血栓形成危险因素的患者可预防性应用低分子量肝素,应用安全、有效。
Objective ：To discuss the risk of venous thromboemboiism （VTE） of spine surgery, the validity and security of low molecular weight heparin（LMWH） as a prophylaxis modality against VTE.Method：156 patients from August 2005 to July 2006 who had undergone spine surgery by the same surgeon group were included in this study.The first group included 62 patients from August 2005 to December 2005.All patients did not have LMWH as a prophylaxis modality against VTE.The second group included 94 patients from January 2006 to July 2006.The patients in the second group were subdivided into two groups：VTE high risk group（62 cases） and VTE low risk group（32 cases）.The patients of VTE high risk group were given LMWH as a prophylaxis modality against VTE.The incidence of VTE in both groups was observed,and wound drainage,mucosal hemorrhage,epidural and wound hematomas,and neural injury symptoms of the patients in the second group were studied.Result：VTE incidence of the first group was 3.2%（2/62）.One case was found DVT without symptom by Doppler Ultrasound 7 days after surgery.The other case suddenly died of pulmonary embolism 5 days after surgery.There were no patients suffered from VTE in the second group.In the second group,there was no difference in amount of wound drainage and blood transfusion between VTE bigh risk and low risk groups （P〉0.05）.Mucosal hemorrhage,epidural and wound hematomas,neural injury symptoms were not discovered in the second group.Conclusion：There is VTE risk in spine surgery.h is effective and safe that the patients undergoing spine surgery have LMWH as a prophylaxis modality against VTE.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第6期434-437,共4页
Chinese Journal of Spine and Spinal Cord
关键词
脊柱
手术
血栓栓塞
预防
Spine
Surgery
Thromboembolism
Prophylaxis
