2022 10 v.15 754-762
骨科大手术加速康复围手术期静脉血栓栓塞症防治专家共识
基金项目(Foundation):
邮箱(Email):
DOI:
中文作者单位:
国家卫生健康委加速康复外科专家委员会骨科专家组;中国研究型医院学会骨科加速康复专业委员会;中国康复技术转化及促进会骨科加速康复专业委员会;四川大学华西医院血管外科;中国医学科学院北京协和医学院北京协和医院骨科;四川大学华西医院骨科;
摘要(Abstract):
静脉血栓栓塞症（VTE）是骨科大手术围手术期的常见并发症，也是患者围手术期死亡及医院内非预期死亡的重要因素之一。如何尽早发现VTE的症状，并进行科学的初步检查、评估和处理是骨科加速康复的重要临床问题。为了进一步加强骨科大手术加速康复围手术期VTE的防治工作，提高医疗质量和安全，国家卫生健康委加速康复外科专家委员会骨科专家组、中国研究型医院学会骨科加速康复专业委员会、中国康复技术转化及促进会骨科加速康复专业委员会联合多学科专家成立骨科加速康复系列共识编写专家委员会，以临床问题为导向，遵循循证医学原则，归纳出8个方面的问题：(1)骨科大手术围手术期VTE防治类型；(2)VTE高风险的评估与预防措施；(3)术前深静脉血栓形成（DVT）的筛查与治疗；(4)术前诊断DVT或小腿静脉血栓的手术时机；(5)术后诊断DVT的治疗；(6)术后诊断小腿静脉血栓的治疗；(7)术前诊断肺栓塞（PE）或PE高风险的诊断与治疗；(8)骨科大手术围手术期VTE药物预防与治疗过程中的出血风险评估。按照上述8个方面的问题进行了文献检索和归纳，结合2016版《中国骨科大手术静脉血栓栓塞症预防指南》、2019版《中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识》及近年国内外最新研究进展，经过反复讨论和修改后形成本共识，期望其为我国骨科大手术加速康复围手术期VTE防治的多学科协作起到积极的推动作用，最终达到加速患者康复的目的。
关键词(KeyWords):
骨科手术;;加速康复外科;;围手术期;;静脉血栓栓塞;;深静脉血栓;;肺栓塞
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参考文献
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[21]Struijk-MulderMC,EttemaHB,Verheyen CC,et al.Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery[J].J Thromb Haemost,2010,8(4):678-683.
[22]Forster R,Stewart M.Anticoagulants (extended duration)for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair[J].Cochrane Database Syst Rev,2016,3:CD004179.
[23]Chen B,Hu N.Low molecular weight heparin and aspirin for prevention of deep vein thrombosis after orthopaedic surgery:a systematic review and meta-analysis[J].J Thromb Thrombolysis,2021,52(2):553-559.
[24]Wilson DGG,Poole WEC,Chauhan SK,et al.Systematic review of aspirin for thromboprophylaxis in modern elective total hip and knee arthroplasty[J].Bone Joint J,2016,98-B(8):1056-1061.
[25]中华医学会血液分会血栓与止血学组.易栓症诊断与防治中国指南(2021年版)[J].中华血液学杂志,2021,42(11):881-888.
[26]谢锦伟,姚欢,岳辰,等.初次髋、膝关节置换术后纤溶变化[J].中国矫形外科杂志,2016,24(10):931-936.
[27]Cao G,Huang Z,Huang Q,et al.Incidence and risk factors for blood transfusion in simultaneous bilateral total joint arthroplasty:a multicenter retrospective study[J].J Arthoplasty,2018,33(7):2087-2091.
[28]Konstantinides SV,Meyer G,Becattini C,et al.2019 ESCGuidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS):the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)[J].Eur Respir J,2019,54(3):1901647.
[29]中华医学会心血管病学分会,中国医师协会心血管内科医分会肺血管疾病学组,中国肺栓塞救治团队(PERT)联盟.急性肺栓塞多学科团队救治中国专家共识[J].中华心血管病杂志,2022,50(1):25-35.
[2]Thirugnanam S,Pinto R,Cook DJ,et al.Economic analyses of venous thromboembolism prevention strategies in hospitalized patients:a systematic review[J].Crit Care,2012,16(2):R43.
[3]Akpinar EE,Hosgun D,Akan B,et al.Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?[J].J Bras Peumol,2013,39(3):280-286.
[4]Dixon J,Ahn E,Zhou L,et al.Venous thromboembolism rates in patients undergoing major hip and knee joint surgery at Waitemata District Health Board:a retrospective audit[J].Intern Med J,2015,45(4):416-422.
[5]钱文伟,翁习生,常晓,等.人工髋关节置换后深静脉血栓形成影响因素的回顾分析[J].中国组织工程研究,2012,16(4):622-625.
[6]Stevens SM,Woller SC,Baumann Kreuziger L,et al.Antithrombotic therapy for VTE disease:second update of the CHEST guideline and expert panel report[J].Chest,2021,160(6):e545-e608.
[7]Mont MA,Jacobs J,Boggio LN,et al.Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty[J].J Am Acad Orthop Surg,2011,19(12):768-776.
[8]中华医学会骨科分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
[9]周宗科,黄泽宇,杨惠林,等.中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识[J].中华骨与关节外科杂志,2019,12(2):81-88.
[10]Caprini JA.Risk assessment as a guide to thrombosis prophylaxis[J].Curr Opin Pulm Med,2010,16(5):448-452.
[11]Szucs G,Hjzner E,Muszbek L,et al.Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery[J].J Orthop Sci,2009,14(5):484-490.
[12]Garcia DA,Baglin TP,Weitz JI,et al.Parenteral anticoagulants:antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest Physicians evidencebased clinical practice guidelines[J].Chest,2012,141(2Suppl):e24S-e43S.
[13]Hirsh J,Bauer K,Donati M,et al.Parenteral anticoagulants:American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)[J].Chest,2008,133(6Suppl):141S-159S.
[14]Palmer AJ,Koppenhagen K,Kirchhof B,et al.Efficacy and safety of low molecular weight heparin,unfractionated heparin and warfarin for thrombo-embolism prophylaxis in orthopaedic surgery:a meta-analysis of randomised clinical trials[J].Haemostasis,1997,27(2):75-84.
[15]Westrich GH,Haas SB,Mosca P,et al.Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty[J].J Bone Joint Surg Br,2000,82(6):795-800.
[16]Kubitza D,Berkowitz SD,Misselwitz F.Evidence-based development and rationale for once-daily rivaroxaban dosing regimens across multiple indications[J].Clin Appl Thromb Hemost,2016,22(5):412-422.
[17]Eriksson BI,Borris LC,Friedman RJ,et al.Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty[J].N Engl J Med,2008,358(26):2765-2775.
[18]Turpie AG,Lassen MR,Davidson BL,et al.Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4):a randomised trial[J].Lancet,2009,373(9676):1673-1680.
[19]Lassen MR,Raskob GE,Gallus A,et al.Apixaban versus enoxaparin for thromboprophylaxis after knee replacement(ADVANCE-2):a randomised double-blind trial[J].Lancet,2010,375:807-815.
[20]Lassen MR,Gallus A,Raskob GE,et al.Apixaban versus enoxaparin for thromboprophylaxis after hip replacement[J].N Engl J Med,2010,363(26):2487-2498.
[21]Struijk-MulderMC,EttemaHB,Verheyen CC,et al.Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery[J].J Thromb Haemost,2010,8(4):678-683.
[22]Forster R,Stewart M.Anticoagulants (extended duration)for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair[J].Cochrane Database Syst Rev,2016,3:CD004179.
[23]Chen B,Hu N.Low molecular weight heparin and aspirin for prevention of deep vein thrombosis after orthopaedic surgery:a systematic review and meta-analysis[J].J Thromb Thrombolysis,2021,52(2):553-559.
[24]Wilson DGG,Poole WEC,Chauhan SK,et al.Systematic review of aspirin for thromboprophylaxis in modern elective total hip and knee arthroplasty[J].Bone Joint J,2016,98-B(8):1056-1061.
[25]中华医学会血液分会血栓与止血学组.易栓症诊断与防治中国指南(2021年版)[J].中华血液学杂志,2021,42(11):881-888.
[26]谢锦伟,姚欢,岳辰,等.初次髋、膝关节置换术后纤溶变化[J].中国矫形外科杂志,2016,24(10):931-936.
[27]Cao G,Huang Z,Huang Q,et al.Incidence and risk factors for blood transfusion in simultaneous bilateral total joint arthroplasty:a multicenter retrospective study[J].J Arthoplasty,2018,33(7):2087-2091.
[28]Konstantinides SV,Meyer G,Becattini C,et al.2019 ESCGuidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS):the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)[J].Eur Respir J,2019,54(3):1901647.
[29]中华医学会心血管病学分会,中国医师协会心血管内科医分会肺血管疾病学组,中国肺栓塞救治团队(PERT)联盟.急性肺栓塞多学科团队救治中国专家共识[J].中华心血管病杂志,2022,50(1):25-35.
基本信息:
DOI：
中图分类号:R687.3;R543.6
引用信息:
[1]赵纪春,邱贵兴,裴福兴等.骨科大手术加速康复围手术期静脉血栓栓塞症防治专家共识[J],2022,15(10):754-762.
基金信息: