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1、腰椎滑脱术后第7天 肺栓塞死亡,Total hip replacement, THR,Total knee replacement, TKR,Hip fractures surgery, HFS,Spine Surgery,脊柱手术后VTE的风险与预防,济南军区总医院 骨病科,1.脊柱手术后VTE的发生率是多少？,2.预防措施有那些？是否有效？,3.药物预防存在什么风险？,1. Overall rate of VTE after spinal surgery,Cheng JS, Arnold PM, Anderson PA, et al. Anticoagulation risk in spi
2、ne surgery. Spine, 2010, 20;35(9 Suppl):S117-S124.,15 Studies,Overall rate of DVT is 2.6% (69/2627),DVT,Overall rate of PE is 0.69% (18/2627),PE,Overall rate of Fatal PE is 0.08% (2/2627),Fatal PE,2. Mechanical prophylaxis,Rokito,329 patients,0.3% (1/329),Rokito SE, Schwartz MC, Neuwirth MG. Deep ve
3、in thrombosis after major reconstructive spinal surgery.Spine, 1996, 1(7):853-858.,Wood,136 patients,1.5% (2/136),Wood KB, Kos PB, Abnet JK, et al. Prevention of deep-vein thrombosis after major spinal surgery: a comparison study of external devices. J Spinal Disord. 1997,10(3):209-214.,DVT,Chemopro
4、phylaxis,Cheng JS, Arnold PM, Anderson PA, et al. Anticoagulation risk in spine surgery. Spine, 2010, 20;35(9 Suppl):S117-S124.,0.33% (9/2732),0.21% (6/2732),Cheng JS, Arnold PM, Anderson PA, et al. Anticoagulation risk in spine surgery. Spine, 2010, 20;35(9 Suppl):S117-S124.,3.The risk of chemoprop
5、hylaxis,5.12% (26/508),0.81% (20/2462),0.39% (10/2507),A 56-year-old patient who had underwent a posterior cervical laminectomy and fusion for cervical spondylitic myelopathy,Cheng JS, Arnold PM, Anderson PA, et al. Anticoagulation risk in spine surgery. Spine, 2010, 20;35(9 Suppl):S117-S124.,Mechan
6、ical compression devices in the lower extremities are suggested . Initiation of mechanical compression just prior to or at the beginning of surgery and continuation until the patient is fully ambulatory is a reasonable practice.,Chemoprophylaxis may not be warranted in most common elective spine sur
7、geries. LMWH may be used after surgery after elective combined anterior-posterior spine surgery or in patients identified as having a high risk for VTE, such as multiple trauma, malignancy, or hypercoagulable state.,For patients with additional risk factors such as advanced age, malignancy, presence
8、 of neurologic deficit, previous thromboembolism, or an anterior surgical approach. Any of the following prophylaxis options are recommended: (1) postoperative low dose unfractionated heparin (LDUH) alone (2) postoperative LMWH alone (3) perioperative intermittent pneumatic compression (IPC) alone.,“不为良相，愿为良医” 北宋 范仲淹,“Either to be a good prime minister or to be an excellent doctor” The Lancet, Volume 376, Issue 9742, Page 657, 28 August 2010,“病人以性命相托，我们怎能不诚惶诚恐，如临深渊，如履薄冰” 医学泰斗，湘雅精神缔造者张孝骞,
