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腰椎滑脱术后第7天肺栓塞死亡,Totalhipreplacement,THR,Totalkneereplacement,TKR,Hipfracturessurgery,HFS,SpineSurgery,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.OverallrateofVTEafterspinalsurgery,ChengJS,ArnoldPM,AndersonPA,etal.Anticoagulationriskinspinesurgery.Spine,2010,20;35(9Suppl):S117-S124.,15Studies,OverallrateofDVTis2.6%(69/2627),DVT,OverallrateofPEis0.69%(18/2627),PE,OverallrateofFatalPEis0.08%(2/2627),FatalPE,2.Mechanicalprophylaxis,Rokito,329patients,0.3%(1/329),RokitoSE,SchwartzMC,NeuwirthMG.Deepveinthrombosisaftermajorreconstructivespinalsurgery.Spine,1996,1(7):853-858.,Wood,136patients,1.5%(2/136),WoodKB,KosPB,AbnetJK,etal.Preventionofdeep-veinthrombosisaftermajorspinalsurgery:acomparisonstudyofexternaldevices.JSpinalDisord.1997,10(3):209-214.,DVT,Chemoprophylaxis,ChengJS,ArnoldPM,AndersonPA,etal.Anticoagulationriskinspinesurgery.Spine,2010,20;35(9Suppl):S117-S124.,0.33%(9/2732),0.21%(6/2732),ChengJS,ArnoldPM,AndersonPA,etal.Anticoagulationriskinspinesurgery.Spine,2010,20;35(9Suppl):S117-S124.,3.Theriskofchemoprophylaxis,5.12%(26/508),0.81%(20/2462),0.39%(10/2507),A56-year-oldpatientwhohadunderwentaposteriorcervicallaminectomyandfusionforcervicalspondyliticmyelopathy,ChengJS,ArnoldPM,AndersonPA,etal.Anticoagulationriskinspinesurgery.Spine,2010,20;35(9Suppl):S117-S124.,Mechanicalcompressiondevicesinthelowerextremitiesaresuggested.Initiationofmechanicalcompressionjustpriortooratthebeginningofsurgeryandcontinuationuntilthepatientisfullyambulatoryisareasonablepractice.,Chemoprophylaxismaynotbewarrantedinmostcommonelectivespinesurgeries.LMWHmaybeusedaftersurgeryafterelectivecombinedanterior-posteriorspinesurgeryorinpatientsidentifiedashavingahighriskforVTE,suchasmultipletrauma,malignancy,orhypercoagulablestate.,Forpatientswithadditionalriskfactorssuchasadvancedage,malignancy,presenceofneurologicdeficit,previousthromboembolism,orananteriorsurgicalapproach.Anyofthefollowingprophylaxisoptionsarerecommended:(1)postoperativelowdoseunfractionatedheparin(LDUH)alone(2)postoperativeLMWHalone(3)perioperativeintermittentpneumaticcompression(IPC)alone.,“不为良相，愿为良医”北宋范仲淹,“Eithertobeagoodprimeministerortobeanexcellentdoctor”TheLancet,Volume376,Issue9742,Page657,28August2010,“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,
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