《静脉血栓栓塞》ppt课件.ppt
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1、,静脉血栓栓塞,危重患者的VTE高危因素和发病率 危重患者的VTE预防指南和评估 ICU内的VTE预防方法 几个肺栓塞病例,Covidien | May 29, 2019 | Confidential,3 |,静脉血栓栓塞症(VTE)包括深静脉血栓(DVT)和肺栓塞(PE)。,Definition of Venous Thromboembolism (VTE) 静脉血栓栓塞的定义,Pulmonary Embolism,1Circulation 1996;93:2212; 2N Engl J Med 2004;350:2257 3Lancet 1997;349:759; 4J Gen Inter
2、n Med 2000;26:425,Fatal PE,Asymptomatic PE,Symptomatic DVT,Pulmonary Embolism,4 out of 5 patients will not have any symptoms of thrombosis,Asymptomatic DVT,20%,80%,80% ASYMPTOMATICS,Confidential, Tyco Corporation,Covidien | 29 May 2019 | Confidential,5 |,解决,DVT的后果,静脉血栓栓塞-,Covidien | 29 May 2019 | Co
3、nfidential,Confidential, Tyco Corporation,6 |,血流淤滞,血管壁损伤,凝血功能改变,血液循环流速减慢。血流淤滞同时发生在术中和术后的卧床时间,发生在术侧肢体的操作过程中会扭折血管,如全膝或全髋成型术,静脉血液郁积也会造成静脉扩张和内皮细胞损伤。,术后血液中促凝血酶原激酶和纤维蛋白原水平升高,组织损伤处表面凝结被激活都导致了血液的高凝状态。,为什么会形成DVT?,当没有任何预防措施时,DVT在某些专科中的发生率高于50,但是,仅有25的DVT患者会表现出症状,OMeara et al. Prophylaxis for Venous Thromboemb
4、olism in Total Hip Arthroplasty. ORTHOPEDICS.,深静脉血栓流行病学(外科各专业),临床路径推荐,Risk factors for VTE,Active cancer or cancer treatment Age over 60 years Critical care admission Dehydration Known thrombophilias Obesity (body mass index BMI over 30 kg/m2) One or more significant medical comorbidities (for examp
5、le: heart disease; metabolic, endocrine or respiratory pathologies; acute infectious diseases; inflammatory conditions) Personal history or first-degree relative with a history of VTE Use of hormone replacement therapy Use of oestrogen-containing contraceptive therapy Varicose veins with phlebitis F
6、or women who are pregnant or have given birth within the previous 6 weeks,Regard medical patients as being at increased risk of VTE if they:,have had or are expected to have significantly reduced mobility for 3 days or more or are expected to have ongoing reduced mobility relative to their normal st
7、ate and have one or more of the risk factors,Regard surgical patients and patients with trauma as being at increased risk of VTE if they meet one of the following criteria:,surgical procedure with a total anaesthetic and surgical time of more than 90 minutes, or 60 minutes if the surgery involves th
8、e pelvis or lower limb acute surgical admission with inflammatory or intra-abdominal condition expected significant reduction in mobility one or more of the risk factors,Risk factors for bleeding,Active bleeding Acquired bleeding disorders (such as acute liver failure) Concurrent use of anticoagulan
9、ts known to increase the risk of bleeding (such as warfarin with international normalised ratio INR higher than 2) Lumbar puncture/epidural/spinal anaesthesia expected within the next 12 hours Lumbar puncture/epidural/spinal anaesthesia within the previous 4 hours Acute stroke Thrombocytopenia (plat
10、elets less than 75 x 109/l) Uncontrolled systolic hypertension (230/120 mmHg or higher) Untreated inherited bleeding disorders (such as haemophilia and von Willebrands disease),Pharmacological VTE prophylaxis,For example:General medical patients fondaparinux sodium low molecular weight heparin (LMWH
11、) unfractionated heparin (UFH) (for patients with renal failure). Start pharmacological VTE prophylaxis as soon as possible after risk assessment has been completed. Continue until the patient is no longer at increased risk of VTE,Patients with stroke,Patients with cancer Patients with central venou
12、s catheters Patients in palliative care All surgery Cardiac surgery Gastrointestinal, gynaecological, thoracic and urological,物理预防在ICU的优势: ICU患者刚入院时大多具有消化道应激性溃疡出血风险 部分重症患者有凝血功能障碍、肾功能障碍 ICU患者本身情况复杂,用药难以掌握,出血并发症,物理预防:ICU患者不可或缺,19 |,静脉瓣后清除,SCD压力系统提供最佳连续梯度压力模式使股静脉血流速度达到最大 “理想的压力模式为踝部35mmHg,小腿30mmHg,大腿20
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