静脉血栓栓塞-ppt课件.ppt

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1、静脉血栓栓塞危重患者的VTE高危因素和发病率危重患者的VTE预防指南和评估ICU内的VTE预防方法几个肺栓塞病例Covidien

2、30July2021

3、Confidential3

4、静脉血栓栓塞症(VTE)包括深静脉血栓(DVT)和肺栓塞(PE)。DefinitionofVenousThromboembolism(VTE)静脉血栓栓塞的定义PulmonaryEmbolism1Circulation2019;93:2212;2NEnglJMed2019;350:22573Lancet2019;349:759;4JGenInternMed2000;26

5、:425FatalPEAsymptomaticPESymptomaticDVTPulmonaryEmbolism4outof5patientswillnothaveanysymptomsofthrombosisAsymptomaticDVT20%80%80%ASYMPTOMATICS11050100300-1000Confidential,©TycoCorporationCovidien

6、30/07/2021

7、Confidential5

8、解决DVT的后果静脉血栓栓塞--Covidien

9、30/07/2021

10、ConfidentialConfide

11、ntial,©TycoCorporation6

12、血流淤滞血管壁损伤凝血功能改变血液循环流速减慢。血流淤滞同时发生在术中和术后的卧床时间发生在术侧肢体的操作过程中会扭折血管，如全膝或全髋成型术,静脉血液郁积也会造成静脉扩张和内皮细胞损伤。术后血液中促凝血酶原激酶和纤维蛋白原水平升高，组织损伤处表面凝结被激活都导致了血液的高凝状态。为什么会形成DVT？当没有任何预防措施时，DVT在某些专科中的发生率高于50％但是，仅有25％的DVT患者会表现出症状O’Mearaetal.ProphylaxisforVenousThromboembolisminTot

13、alHipArthroplasty.ORTHOPEDICS.深静脉血栓流行病学（外科各专业）ICU入住前存在的高危因素ICU期间获得的高危因素近期手术中心静脉导管创伤、烧伤脓毒症恶性肿瘤和治疗因素药物镇静、麻醉脓毒症机械通气制动/卧床、中风、脊髓损伤肌松治疗高龄药物治疗心脏/呼吸衰竭VTE病史怀孕/产后雌性激素高临床路径推荐RiskfactorsforVTEActivecancerorcancertreatmentAgeover60yearsCriticalcareadmissionDehydrationKnownthrombophiliasOb

14、esity(bodymassindex[BMI]over30kg/m2)Oneormoresignificantmedicalcomorbidities(forexample:heartdisease;metabolic,endocrineorrespiratorypathologies;acuteinfectiousdiseases;inflammatoryconditions)Personalhistoryorfirst-degreerelativewithahistoryofVTEUseofhormonereplacementtherapy

15、Useofoestrogen-containingcontraceptivetherapyVaricoseveinswithphlebitisForwomenwhoarepregnantorhavegivenbirthwithintheprevious6weeksRegardmedicalpatientsasbeingatincreasedriskofVTEifthey:havehadorareexpectedtohavesignificantlyreducedmobilityfor3daysormoreorareexpectedtohaveon

16、goingreducedmobilityrelativetotheirnormalstateandhaveoneormoreoftheriskfactorsRegardsurgicalpatientsandpatientswithtraumaasbeingatincreasedriskofVTEiftheymeetoneofthefollowingcriteria:surgicalprocedurewithatotalanaestheticandsurgicaltimeofmorethan90minutes,or60minutesifthesur

17、geryinvolvesthepelvisorlowerlimbacutesurgicaladmissionwithinflammato