可回收下腔静脉滤器在骨折合并深静脉血栓中的应用

Application of retrievable inferior vena cava filter placement in patients with deep venous thrombosis after fracture

目的探讨下肢/盆骨骨折合并下肢深静脉血栓(DVT)患者置入可回收下腔静脉(IVC)滤器预防围术期肺栓塞(PE)的价值。方法回顾性分析1 891例下肢/盆腔骨折合并DVT患者的临床资料。411例置入永久型滤器的患者未纳入研究,其余患者根据是否置入可回收IVC滤器,将患者分为滤器组(n=843)与对照组(n=637);比较两组患者围术期症状性PE的发生率和死亡率。结果滤器组218例置入Optease型滤器,平均于(14.3±3.6)天取出可回收滤器;625例置入Celcet滤器,其中578例行滤器取出术,566例成功取出滤器(97.92%,566/578),滤器平均留存时间(15.8±4.1)天。与对照组[1.57%(10/637)]相比,滤器组PE发生率[0.12%(1/843)]明显下降(P<0.05)。接受抗凝治疗患者中,滤器组和对照组PE发生率分别为0.14%(1/700)、1.47%(9/612),差异有统计学意义(P<0.05)。结论下肢/盆骨骨折合并DVT患者置入可回收IVC滤器预防围术期症状性或致死性PE安全、有效。

Objective To explore the value of retrievable inferior vena cava （IVC） filter placement for prevention of perioperative pulmonary embolism （PE） in patients with lower extremity/pelvic fracture with deep vein thrombosis （DVT）.Methods Clinical data of 1 891 lower extremity/pelvic fracture patients combined with DVT were retrospectively analyzed. Totally 411 patients with permanent filters were excluded, and the other patients were divided into filter group（n=843） and control group （n=637） according to whether receiving retrievable IVC filter placement or not. The incidence of perioperative symptomatic PE and mortality were compared between the two groups.Results In filter group, Optease nonpermanent filters were inserted in 218 patients, and the mean indwelling time was （14.3±3.6） days. Celcet filters were inserted in 625 patients, and the filters were successfully removed in 566 out of 578 patients who underwent filter removal surgery （97.92%, 566/578）, and the mean indwelling time was （15.8±4.1） days. The incidence of PE in filter group （0.12%[1/843]） was significantly lower than that in control group （1.57%[10/637], P〈0.05）. Among the patients who received chemical anticoagulant therapy, the incidence of PE in filter group and control group was 0.14%（1/700） and 1.47%（9/612）, respectively （P〈0.05）.Conclusion Retrievable IVC filter placement is a safe and effective method for preventing perioperative symptomatic and fatal PE in lower extremity/pelvic fracture patients with DVT.