脊柱术后早期分层预防静脉血栓栓塞症的疗效分析

Efficacy analysis of early hierarchical prevention of venous thromboembolism after spine surgery

目的通过比较采用和不采用术后早期分层预防(EHP)手术相关静脉血栓栓塞症(VTE)发生率及血栓特点,探讨脊柱术后行EHP的有效性和安全性。方法回顾性分析本院2013年12月—2014年12月(未行EHP组,n=607)、2015年3月—2016年3月(EHP组,n=714)2个时间段由同一组术者施行脊柱手术的1 321例患者的临床资料。EHP组依据Caprini血栓风险因素评估表进行评分,并以其提供的VTE预防方案进行分层预防。预防措施为物理预防联合药物预防。于术前、术后下床当天(无法下床者于术后7~14 d)行下肢血管多普勒超声检查评价有无深静脉血栓形成,同时监测术后引流量及引流液颜色,是否有切口血肿、渗血,是否发生硬膜外出血致神经损伤症状,是否发生低分子肝素致血小板减少等。结果未行EHP组607例患者术后VTE发生率为4.61%(28/607),其中1例发生急性肺栓塞者死亡;术后发生切口渗血3例,未出现切口周围血肿及硬膜外血肿。EHP组714例患者术后VTE发生率为2.24%(16/713),未发生急性肺栓塞;发生切口渗血8例、切口周围血肿2例,未出现硬膜外血肿及低分子肝素致血小板减少。两组患者VTE发生率差异有统计学意义(P<0.05)。结论脊柱手术术后有下肢深静脉血栓形成甚至发生肺栓塞的风险,EHP可降低VTE的发生率。

Objective To investigate the efficacy and safety of early hierarchical prevention（EHP） of venous thromboembolism（VTE） after spinal surgery by comparing the incidence and characteristics of VTE-associated with spinal surgery before and after combined physical and drug prevention. Methods The clinical data of 1 321 patients were retrospectively analyzed,who were operated on by the same group of surgeons and divided into without EHP group（undergoing spinal surgery in December 2013 to December 2014,n=607） and EHP group（undergoing spinal surgery in March 2015 to March 2016,n=714）. The patients in group 2 were scored according to the Caprini thrombosis risk factors assessment form and received EHP based on the provided VTE prevention plans with physical and drug intervention. The deep vein thrombosis was evaluated by lower extremity vascular Doppler ultrasonography pre-operation and the first day after getting out-of-bed postoperation. At the same time,the color and volume of drainage,hematoma and errhysis of incision,symptom of neurologic damage leaded by extradural hemorrhage,and the thrombocytopenia by low molecular heparin were monitored. Results In without EHP group,the occurrence rate of VTE was 4.61%（28/607） and 1 patient had acute pulmonary embolism and died. Three patients had incision errhysis,but none had hematomas around the incisions or epidural hematoma. In EHP group,the occurrence rate of VTE was 2.24%（16/713）,and no one had acute pulmonary embolism. Eight patients had incision errhysis and 2 had incision hematoma. No epidural hematoma or thrombocytopenia leaded by low molecular heparin was found. The difference in occurrence rate of VTE between the 2 groups showed statistical significance（P〈0.05）. Conclusion There is a risk of deep vein thrombosis and even pulmonary embolism after spinal surgery,and EHP can reduce the incidence of VTE.