如何正确把握下腔静脉滤器置放术的指征_张福先演示幻灯片.pptVIP

如何正确把握下腔静脉滤器置放术的指征;VTE概念的理解; 　在香港和新加坡， 住院病人中VTE 的发生率15.8 and 17.1 per 10 000，而美国为 130 per 10 000 . ;Incidence of VTE per 10,000 hospital admissions; 在美国每年约250 000 and 20 million cases of DVT需要治疗. 系统抗凝是TVE治疗的主要策略． 然而约有15%的病人抗凝无效或为禁忌症．对于这些病人滤器被考虑和选择． ; Prevalence of pulmonary embolism (PE) and deep venous thrombosis (DVT) at autopsy;Prevalence of pulmonary embolism at autopsy in general hospitals and communities; 通过动物实验和对100例DVT患者与PE发生关系进行前瞻性研究，发现：DVT患者中PE发生率是45%。其中73%无任何临床症状，致死性PE为4%. ;Phlégmatia alba dolens. In:Trousseau A.Clinique médicale de i`H?tel-Dieu de Paris.3rd ed.Vol 3,Paris:J.B.Bailliére.1868:652-695.Greenfield LJ, Michna BA.Twelve-year clinical experience with the Greenfield vena filter.Surgery 1988:104;706-712.;In 400 patients Follow up At 8 years;Indications for IVC filter placement;Indications for IVC filter placement in 1995 and 2005;Distribution of indications for IVC filter placement among all providers during 2005;J Vasc Interv Radiol 2008; 19:393–399;在美国滤器的应用量每年都在递增，而超过一半为预防性的临时滤器．;在没有 DVT or PE病人，但有抗凝禁忌症病例中，应用腔静脉滤器被称为预防性滤器． 在明确诊断 VTE 或 PE or DVT 病人而不能耐受抗凝的病例中，腔静脉滤器应用被称为治疗性滤器．;近年来，在我们把注意都投在大动脉疾病治疗同时， DVT的治疗却有了重大突破． 介入下血栓部位置管溶栓与球囊扩张，血管成型． 而在临时滤器的保护下进行的溶栓更加安全． Catheter-directed thrombolysis(CDT) 6月后与单纯性抗凝相比，血管通畅率是72 %vs 12%, P\0.001，静脉瓣功能正常率为89 %vs 59%, P\0.04.　PTS明显减少. ;;Kaufman JA, Kinney TB, Streiff MB et al.: Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference.J Vasc Interv Radiol 2006; 17: 449–59.;Cuschieri J, Freeman B, O’Keefe G, Harbrecht BG, Bankey P, Johnson JL, et al. Inflammation and the host response to injury a large-scale collaborative project: patient-oriented research core standard operating procedure for clinical care X. Guidelines for venous thromboembolism prophylaxis in the trauma patient. J Trauma 2008;65:944-50.;Long-term follow-up of trauma patients with permanent prophylactic vena cava filters.;肿瘤病人发生