关节置换下肢深静脉血栓形成的危险因素及预防

Risk factors and prevention of lower limb deep vein thrombosis after total arthroplasty of major joint

静脉血栓栓塞症(VTE)是骨科大手术,尤其是髋膝关节置换后发生率较高的并发症,也是患者围手术期死亡的重要原因之一。VTE主要有两种临床表现形式,一是深静脉血栓形成(DVT),二是肺动脉血栓栓塞症(PTE)。VTE发生的危险因素是多方面、多层次的。炎症相关因子、同型半胱氨酸等在DVT发生发展中起重要作用。在分子调控层面,多个调节因子如由内皮细胞表达的微小RNA(miRNA)和mRNA、沉默信息调节因子1等均参与了DVT发生。临床上已采用检测指标,如D-二聚体水平、炎性细胞比值等,较好预测DVT发生。在重视三大病因的基础上,对新的危险因素予以适当的评估干预将有助于指导临床VTE的诊治预防及改善患者预后。

Venous thromboembolism(VTE)is a common complication secondary to major orthopaedic procedures,especially total hip arthroplasty or total knee arthroplasty,also is one of common causes leading to perioperative death.There are two main forms of VTE in clinical presentation,including deep vein thrombosis(DVT)and pulmonary thromboembolism(PTE).The risk factors related to VTE involve multiple aspects in multiple levels.Inflammatory factors and homocysteine play important roles in the development of DVT.At the level of molecular regulation,several regulatory factors,such as microRNA(miRNA)expressed by endothelial cells,mRNA and silence information regulator 1,take part in the occurrence of DVT.In clinical setting,some indicators,such as D-dimer level and inflammatory cell ratio,have been used to predict DVT well.On the basis of paying attention to the three major pathogeneses,appropriate assessment and intervention of new risk factors will be helpful for diagnosis,treatment,prevention of clinical VTE and improve prognosis of DVT.