骨科深静脉血栓的预防治疗研究进展

发布时间：2018-03-03 13:07

本文选题：骨科　切入点：深静脉血栓　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：深静脉血栓(Deep venous thrombosis, DVT)作为骨科术后最常见的并发症,在临床中越来越被重视,目前存在很多深静脉血栓的防治指南,但各个指南对血栓预防药物的选择以及使用时机均缺少高等级的证据支持。而抗血栓药物又往往伴随出血风险,需引起足够重视。本文通过对深静脉血栓形成的三大要素：静脉血流滞缓、静脉壁损伤和血液高凝状态进行分析,阐述了骨科高深静脉血栓发病率原因。同时将骨科深静脉血栓危险因素分为强、中、弱三个等级,并列举了常见发病人群。随后本文对深静脉血栓预防采用的物理和药物措施进行了逐一分析,通过对比新型抗凝药物和传统抗凝药物,大型骨科术后的可选磺达肝葵钠抗凝,而膝关节置换术更推荐伐沙班,仍不建议将阿司匹林与华法林用作常规抗凝治疗。对于因下肢软组织创伤而采用石膏绷带制动的患者,通常忽略其较高的静脉血栓发病风险,所以,我们建议,必要时也需使用抗凝药物。对于下肢长骨骨折的患者,尽早恢复肢体长度并通过手术固定能有效降低静脉血栓的发生率。对于髋、膝关节置换术后患肢,必要时延长抗凝疗程可获得更好收益。
[Abstract]:Deep venous thrombosis (DVT), as the most common complication after orthopedic surgery, has been paid more and more attention in clinic. There are many guidelines for the prevention and treatment of DVT. But guidelines lack high-level evidence for the choice and timing of thromboprophylaxis. Antithrombotic drugs, in turn, tend to be associated with a risk of bleeding. In this paper, we analyzed the three main factors of deep venous thrombosis: slow venous flow, injury of venous wall and hypercoagulability. The causes of the incidence of high deep venous thrombosis in orthopedic department were expounded, and the risk factors of deep venous thrombosis in orthopedic department were divided into three grades: strong, middle and weak. Then the physical and pharmacological measures used in the prevention of deep venous thrombosis were analyzed one by one. By comparing new anticoagulants and traditional anticoagulants, the optional sulfodrate liver sunflower sodium anticoagulant after large orthopedic surgery was compared. For knee arthroplasty, Vashaban is also recommended, and aspirin and warfarin are not recommended for routine anticoagulant therapy. For patients with lower extremity soft tissue trauma with plaster bandage immobilization, the higher risk of venous thrombosis is usually ignored. Therefore, we suggest that anticoagulants should also be used when necessary. For patients with long bone fractures of the lower extremities, early recovery of limb length and reduction of the incidence of venous thrombosis through surgical fixation can effectively reduce the incidence of venous thrombosis. If necessary, prolonging the anticoagulant treatment may yield better results.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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