下肢深静脉血栓形成防治.ppt

下肢深静脉血栓形成防治
Introduction
下肢深静脉血栓形成
Deep vein thrombosis DVT
发生率 32-88%（无预防措施）
15-
Enoxaparin
842
*
Lieberman and Sung et al. [23]
Warfarin
815
†
Paiement and Wessinger et al. [31]
Warfarin
268

Authors
Agent
N
Bleeding Complications (%)
Heit and Berkowite et al.
Warfarin
279

Ardeparin
277

Hull and Raskob
Warfarin
324

Logiparin
317

LeClerc and Gent et al.
Warfarin
334

Enoxaparin
842
*
Lieberman and Sung et al.
Warfarin
815
†
Paiement and Wessinger et al. [
Warfarin
268

Prevention for DVT
Prevention for DVT
（LMWHs）
enoxaparin，fondaparinux， ximelagatran
开始时间：术前一天（欧洲）
术后12-24小时（北美）
持续时间：7d-21d
检测凝血指标
减少DVT发生率40-70%
Prevention for DVT
OREF一致认为
Orthopedic research education foundation
2019,CA,USA
DVT要进行预防
Prevention for DVT
OREF
Oral warfarin (%)
Aspirin (%)
Elastic stocking (%)
LMWHs (%)
UFHs (10%)
Pentosacharides (%)
Treatment of DVT
溶栓治疗
尿激酶
介入治疗
下腔静脉滤网成形术
取栓术：DVT早期，价格昂贵
髂股静脉Fogarty导管取栓术
（1）通过右下肢大隐静脉分支，插入第一根Fogarty导管至下腔静脉，鼓张气囊，以防栓塞；从左下肢股静脉切开插入第二根导管达血栓近侧。
（2）鼓张左侧第二根导管的气囊后，连同气囊，缓缓地拉出。萎瘪第一根导管的气囊，恢复血液回流。
髂股静脉Fogarty导管取栓术
Outcome of DVT
部分再通(revascularization)
下肢深静脉血栓形成后综合征 (post-DVT syndrome)
发生PE
Introduction of PE
预防DVT主要目的是避免PE的发生
发生率
DVT PE
THA 45-57% -%
TKA 40-84% -%
髋部骨折 36-60% -%
Incidence of PE
% (1990s)
% (1960s)
?
Clinical manifestation of PE
Symptoms of Pulmonary Embolism
The symptoms are frequently nonspecific and can mimic many other cardiopulmonary events.
Shortness of breath
Rapid pulse
Sweating
Sharp chest pain
Bloody sputum (coughing up blood)
Fainting
PE in USA
It is estimated that each year more than 600,000 patients suffer a pulmonary embolism.
PE causes or contributes to