骨科大手术加速康复围手术期静脉血栓栓塞症防治专家共识

Expert consensus on the prevention and treatment of perioperative venous thromboembolism in major orthopaedic surgery in enhanced recovery after surgery program

静脉血栓栓塞症(VTE)是骨科大手术围手术期的常见并发症,也是患者围手术期死亡及医院内非预期死亡的重要因素之一。如何尽早发现VTE的症状,并进行科学的初步检查、评估和处理是骨科加速康复的重要临床问题。为了进一步加强骨科大手术加速康复围手术期VTE的防治工作,提高医疗质量和安全,国家卫生健康委加速康复外科专家委员会骨科专家组、中国研究型医院学会骨科加速康复专业委员会、中国康复技术转化及促进会骨科加速康复专业委员会联合多学科专家成立骨科加速康复系列共识编写专家委员会,以临床问题为导向,遵循循证医学原则,归纳出8个方面的问题:(1)骨科大手术围手术期VTE防治类型;(2)VTE高风险的评估与预防措施;(3)术前深静脉血栓形成(DVT)的筛查与治疗;(4)术前诊断DVT或小腿静脉血栓的手术时机;(5)术后诊断DVT的治疗;(6)术后诊断小腿静脉血栓的治疗;(7)术前诊断肺栓塞(PE)或PE高风险的诊断与治疗;(8)骨科大手术围手术期VTE药物预防与治疗过程中的出血风险评估。按照上述8个方面的问题进行了文献检索和归纳,结合2016版《中国骨科大手术静脉血栓栓塞症预防指南》、2019版《中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识》及近年国内外最新研究进展,经过反复讨论和修改后形成本共识,期望其为我国骨科大手术加速康复围手术期VTE防治的多学科协作起到积极的推动作用,最终达到加速患者康复的目的。

Venous thromboembolism(VTE)is a common complication in the perioperative period of major orthopaedic surgery and also one of the important factors for perioperative death and unexpected deaths in hospital.It is a crucial clinical task for enhanced recovery after surgery(ERAS)to detect the symptoms of VTE as early as possible,and carry out scientific preliminary examination,evaluation and treatment.In order to guide orthopaedic surgeons to better prevent and treat perioperative VTE,Orthopaedic Expert Group of ERAS profession Committee of National Health Commission,Orthopaedic ERAS profession Committee of Chinese Research Hospital Association,Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion,together with experts from related disciplines,established a collaborative expert committee for this consensus writing.Focusing on the clinical problems and following evidence-based medicine principles,the experts summarized the following eight aspects:(1)modes of prevention and treatment of perioperative VTE;(2)assessment and prevention of potential VTE;(3)screening and treatment of preoperative potential deep vein thrombosis(DVT);(4)timing of surgery for patients diagnosed DVT or calf venous thrombosis;(5)treatment of DVT diagnosed after surgery;(6)treatment of patients diagnosed as calf venous thrombosis after surgery;(7)diagnosis and treatment of patients with pulmonary embolism(PE)or high risk of PE before surgery;(8)risk assessment of bleeding during VTE prevention and treatment with medicine.Around these eight aspects,literature was searched and induced,and the latest researches of recent five years were referenced as well as the 2016 edition of Prevention of venous thromboembolism after major orthopaedic surgery and 2019 edition of Expert consensus on the application of tranexamic acid and anticoagulant for the enhanced recovery after orthopaedic surgery in China.Through repeated discussions and revisions,this consensus was developed hoping to promote the multidisciplinary cooperation and realize rapid recovery for patients.