骨科大手术后静脉血栓栓塞症的研究进展  

Prevention of venous thromboembolism following major orthopedic surgery

作　　者：马信龙[1] 张建敏[2] 马剑雄[1] 田爱现 孙晓雷[1] 

机构地区：[1]天津市天津医院骨科研究所,300052 [2]浙江省台州医院骨科,317000

出　　处：《中华骨科杂志》2016年第15期995-1001,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目（81572154）;天津市卫生局科技攻关项目（15KG123）;吴阶平医学基金会临床科研专项资助项目（320.6750.15185）;卫生部医药卫生科技发展研究中心（W2013ZT058）;天津市科技支撑重点项目（13ZCZDSY01700）

摘　　要：静脉血栓栓塞症（venous thromboembolism，VTE）是指血液在静脉内不正常地凝结导致的血管完全或不完全阻塞，属静脉回流障碍性疾病。VTE主要表现为深静脉血栓形成（deep venous thrombosis，DVT）和肺栓塞（pulmonary embolism，PE），是骨科大手术（全髋关节置换、全膝关节置换、髋部骨折）术后常见的一种并发症。国外文献报道关节置换术后VTE的发生率高达42％~57％。既往观点认为DVT和PE是VTE两个内在关联的不同类型，但最新研究结果提示在关节置换术后患者DVT和PE的形成可能是两个独立的事件。骨科大手术后VTE的预防主要包括基本预防、物理预防和药物预防。物理预防联合药物预防在预防远端DVT方面优于单纯药物预防。达比加群、阿哌沙班、利伐沙班等新型口服抗凝药，在有效性、安全性等方面优于低分子肝素等传统药物。低分子肝素抗凝效果显著，但却不能口服。近期研究发现患者住院时接受低分子肝素注射，出院后接受阿司匹林、利伐沙班或达比加群口服的分阶段转换疗法预防VTE安全有效。Venous thromboembolism （VTE） is a kind of venous disorder that the abnormal condensation of blood within the vein, leading to complete or incomplete vein obstruction. VTE is mainly a combination of deep vein thrombosis （DVT） and pulmonary embolism （PE） and is an important complication after major orthopedic surgery （total hip arthroplasty, total knee arthroplasty, hip fracture surgery）. Foreign literature reported that incidence rate of VTE after arthroplasty was as high as 42%-57%. Conventional notion was that DVT and PE were two different but interrelated types of VTE, while the latest research reported that the formation of DVT and PE after arthroplasty may be two events individually. Prevention of VTE after major orthopedic surgery includes general, pharmacological and mechanical methods. The efficacy of physical combined with pharmacological methods was better than drug prevention alone in preventing distal DVT. Dabigatran, apixaban, rivaroxaban and other new oral anticoagulants were better than low molecular weight heparin and other traditional medicines in effectiveness and safety. The effects of low molecular weight heparin are remarkable, while it cannot take orally. A recent study found that staged VTE prophylaxis, namely patients received low molecular weight heparin injection in hospital, and received aspi- rin, rivaroxaban or dabigatran orally after discharge is safe and effective in prevention of VTE.

关 键 词：静脉血栓栓塞症 骨科大手术 手术后 静脉回流障碍性疾病 全髋关节置换 口服抗凝药 低分子肝素 药物预防 

分 类 号：R687[医药卫生—骨科学] R543.6[医药卫生—外科学]