下肢骨创伤并深静脉血栓行下腔静脉滤器植入的单中心回顾性研究  

A single-center retrospective study on the intraluminal implantation of inferior vena cava filter for the lower extremity trauma patients with deep venous thrombosis

作　　者：潘烨[1] 赵珺[1] 孙玉强[2] 陈云峰[2] 周晓辉[3] 夏荣刚[2] 邵明哲[1] 张健[1] 吴海生[1] 

机构地区：[1]上海交通大学附属第六人民医院血管外科,200233 [2]上海交通大学附属第六人民医院骨科,200233 [3]上海交通大学附属第六人民医院医务处,200233

出　　处：《中华外科杂志》2014年第4期254-257,共4页Chinese Journal of Surgery

摘　　要：目的 探讨下腔静脉滤器预防骨创伤合并下肢深静脉血栓（DVT）患者围手术期肺栓塞的有效性和安全性.方法 回顾性分析2003年1月至2012年12月下肢和骨盆骨创伤合并下肢DVT患者2 248例.其中2003年1月至2007年12月未开展滤器植入手术的1 052例患者设为早期无滤器组,2008年1月至2012年12月间712例植入下腔静脉滤器的患者设为滤器组,2008年1月至2012年12月484例未植入滤器的患者设为后期无滤器组.除早期无滤器组与滤器组年龄无差异,三组间其他基线情况均存在差异.使用x2检验比较三组肺栓塞发生情况.结果 3组共发生各种症状性肺栓塞31例,因急性肺栓塞死亡12例.滤器组植入712枚滤器,无致死性并发症.滤器组、早期无滤器组和后期无滤器组症状性肺栓塞发生率分别为0.14％、2.19％和1.45％,急性肺栓塞病死率分别为0、0.86％和0.62％.早期无滤器组、后期无滤器组的症状性肺栓塞发生率均高于滤器组（x2=11.762,P=0.001;x2=7.395,P=0.007）,病死率亦高于滤器组（x2=6.122,P=0.013;x2=4.424,P=0.035）.结论 下腔静脉滤器可预防下肢骨创伤并DVT患者围手术期症状性和致死性肺栓塞.Objective To evaluate the application of inferior vena cava filter （IVCF） in prevention of peri-operative pulmonary embolism （PE） in lower limb bone fracture patients with deep venous thrombosis （DVT）.Methods From January 2003 to December 2012,2 248 cases of lower limb and pelvic fractures with DVT were retrospectively analyzed.Before the procedure of IVCF implantation began,January 2003 to December 2007,there were 1 052 cases of acute trauma patients with DVT were classified as the group of early none-IVCF.The IVCF implantation was began since January 2008.From that trime to December 2012,712 cases of bone fractures with DVT received filter implantation,which were classified as IVCF group.The other 484 patients who had not undergone filter deployment were divided as group of late none-IVCF.The baseline conditions of the three groups were significantly different in addition to the ages between group of early none-IVCF and IVCF group.The incidences of PE and mortality of PE in each group were recorded and analyzed by x2 test.Results There were totally 31 cases of symptomatic PE,among which 12 cases died.Totally 712 filters were deployed successfully without any major complications.The incidences of symptomatic PE were 0.14％ （1/712）,2.19％ （23/1 052） and 1.45％ （7/484） in IVCF group,group of early none-IVCF and group of late none-IVCF,respectively.The mortality of PE were 0 （0/712）,0.86％ （9/1 052） and 0.62％ （3/484） in these groups.The incidence of symptomatic PE in IVCF group was significantly different from that in the group of early and late none-IVCF （x2 =11.762,P =0.001 ; x2 =7.395,P =0.007,respectively）.The mortality of IVCF group was also significantly lower compared with the other two groups （x2 =6.122,P =0.013 ; x2 =4.424,P =0.035,respectively）.Conclusion IVCF implantation effectively prevents symptomatic and fatal PE of patients of lower limb and pelvic fractures with DVT in the peri-operative period.

关 键 词：静脉血栓形成 肺栓塞 下肢 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]