脊柱术后静脉血栓栓塞症药物预防的研究进展

Review of anticoagulant medicine prevention for venous thromboembolism after spinal surgery

静脉血栓栓塞症(venous thromboembolism,VTE)是骨科手术后灾难性的并发症,有较高的致死率,是患者围术期死亡以及医院内非预期死亡的重要原因之一。膝髋关节置换和髋部骨折手术后,预防性应用抗凝药物已经成为临床实践的常规。但脊柱疾病术后使用抗凝药物的意见不统一,并且脊柱术后所特有的出血并发症——硬膜外血肿,也可能会造成严重的后果。越来越多的研究发现,存在血栓高危因素的脊柱手术患者中,术后VTE的发生率很高。目前已开始尝试在脊柱术后预防性使用抗凝药物。本文通过复习相关文献,综述了近年来脊柱疾病术后VTE的发生率、危险因素、风险评估与诊断、预防措施、药物预防的作用以及并发症等研究的进展,以期能够给临床提供参考。

Venous thromboembolism(VTE)is a catastrophic complication after orthopedic surgery.It will lead to high mortality.VTE is one of the most important factors that cause the unpredictable death of inpatients perioperatively.Pharmacological prophylaxis is the routine after total knee arthroplasty,total hip arthroplasty and hip fracture operation.However there is a controversy about whether pharmacological prophylaxis should be administrated after spinal surgery.One reason is due to the unique hemorrhagic complications such as epidural hematoma which can also lead to the catastrophic consequence.Nowadays,more and more studies have shown that the rate of VTE is higher than we expected in the spinal patients with high risks and the safety and efficiency of postoperative pharmacological prophylaxis has been reported in many papers.Therefore,we have reviewed these studies about prevalence,risk factors,risk assessment and diagnosis,prophylaxis,effectiveness and complications of pharmacological prophylaxis for VTE and provide useful information to the clinics.