从重症监护角度思考普通外科围手术期静脉血栓栓塞症防治

Prevention and treatment of venous thromboembolism in perioperative patients:Thinking from the perspective of intensive care

普通外科围手术期病人,尤其是重症监护病人存在多种容易导致血栓形成的高危因素,因而较之其他病人,具有更高的静脉血栓栓塞症(VTE)发病风险,在该类人群中切实做好VTE防治工作刻不容缓。准确评估发病风险,是做好VTE的防治工作的关键第一步。目前常用的Caprini模型对于预测围手术期病人的血栓风险具有较高的敏感度,临床上将血浆标记物与该模型相结合,可进一步提高重症监护病人VTE风险的预测价值。重症病人的VTE预防及治疗须强调个体化,综合评价血栓与出血的风险,兼顾有效性及安全性,选择最佳策略和最优剂量,改善病人预后。

The perioperative patients,especially the intensive care patients,have a variety of high-risk factors to cause thrombosis and have higher risks of venous thromboembolism(VTE)incidence.It is urgent to prevent and treat VTE in this kind of population.As for the VTE prevention and treatment,the evaluation of risks is the first key step.At present,the commonly used Caprini Model has a high sensitivity to predict the risk of VTE in perioperative patients.Combining plasma markers with Caprini model can further improve the predictive value in intensive care patients.The prevention and treatment of VTE in intensive care patients should emphasize individualization,comprehensively evaluate the risks of thrombus and hemorrhage,take the effectiveness and safety into account,and select the best strategy and the optimal dose,so as to improve the prognosis of patients.