急性创伤性深静脉血栓滤器选择研究

Selection of vena cava filters in traumatic deep venous thrombosis

目的:探讨急性下肢创伤后继发深静脉血栓滤器使用指征及滤器种类选择。方法:遵循以往滤器使用的选择原则,对2010年度下肢创伤后继发急性深静脉血栓患者,分别选用临时、可回收及永久性滤器进行分类比较研究。结果:共计筛查下肢创伤患者4 544例,DVT阳性968例,发病率21.3%。使用滤器296例,其中临时性121例(40.9%),可回收56例(18.9%),永久性119例(40.2%)。滤器置入过程中未发现致命性肺栓塞及明显的症状性肺栓塞。抗凝治疗随访3～6个月,复发2例。结论:下肢创伤手术术前发现急性深静脉血栓,在手术前置入下腔静脉滤器,能大大降低致命性肺栓塞的发生率。由于创伤患者的血栓栓塞症的危险是临时的,应首选临时性滤器。高龄患者或有严重心肺并发症患者,适合放置可回收滤器。术后发现的深静脉血栓及术前可以明确的陈旧性深静脉血栓患者,置入滤器不是必须的。

Objective：To explore the indicators of vena cava filters（VCFs） implementation in case of deep venous thrombosis（DVT） secondary to lower extremity trauma and how to select among different types of VCFs.Methods：Based on the previous VCF guideline,DVT patients secondary to lower extremity trauma treated in our hospital in the year of 2010 were categorized into the following subgroups and analyzed separately： implanted temporary VCFs;implanted retrievable VCFs;implanted permanent VCFs.Results：Totally 4 544 subjects were screened and 968 patients were diagnosed with DVT.The DVT incidence is 21.3%.VCFs were implanted in 296 patients.Among them,121 patients received temporary VCFs（40.9%）,56 subjects received retrievable VCFs（18.9%） and permanent VCFs were implanted in 119 cases（40.2%）.No fatal pulmonary embolism（PE） or significant symptomatic PE were identified while VCFs were implanted.Post surgery,anti-coagulants were administrated and subjects were followed up to three to six month.Two DVT relapses were identified during follow-up.Conclusion：If acute DVT was diagnosed in lower limb trauma patients,VCF implantation before surgery can greatly reduce the incidence of fatal PE.Since the risk of thromboembolism in trauma patients are transient,temporary VCFs are the first choice.Retrievable VCFs are indicated in elderly patients or patients with severe cardiac-pulmonary complications.VCF implantation is not obligatory if thrombus was identified post-surgery or obsolete in nature identified before surgery.