住院患者肺栓塞的早期识别预防及治疗课件.ppt

VTE预防的方法 基本预防措施 物理预防 药物预防 基本预防措施 手术操作应轻巧，避免静脉内膜损伤 规范下肢止血带的应用 卧床时抬高患肢 多做深呼吸及咳嗽动作 术后尽早下床活动 鼓励患者多做踝关节，腓肠肌和股四头肌活动或被动运动 术中或术后补液，避免脱水而增加血液黏稠 物理预防 足底泵 弹力袜 IPC 间歇充气加压装置 药物预防 肝素 低分子肝素 华法林 磺达肝癸钠 利伐沙班 住院患者 VTE预防 2008年ACCP8中有一系列（16项）针对住院患者预防深静脉血栓形成的措施，包括： 骨科手术 、妇科手术 、普通外科手术、血管外科手术 、泌尿外科 、外科冠状动脉搭桥术 、急性脊髓损伤 、神经外科 手术、胸外手术、癌症患者 、创伤 、烧伤 、内科疾病 、重症监护 、肥胖症手术 、长途旅行 2010年中国骨科大手术静脉血栓栓塞症预防指南 内科疾病（2008年ACCP--8） 1.在病情严重的内科疾病患者应用低剂量普通肝素（级别1A级）低分子肝素（级别1A级）或磺达肝癸钠（级别1A级）进行预防。 这些患者包括因充血性心力衰竭或严重呼吸系统疾病住院的患者，卧床并且伴有一项或多项其他危险因素：活动期癌症、静脉血栓病史、脓毒症、急性神经系统疾病和炎症性肠病。 2.在有静脉血栓症危险因素和抗凝剂预防禁忌症的内科患者，应当应用逐段加压袜或间歇气囊压迫这些机械预防方法（级别1A）。 小 结 “三高一低”的临床特点 可防可治. “防”先于“治” 增强意识，提高警惕 早期诊断、规范治疗 * * VTE is often silent and difficult to diagnose : Approximately 80% of all DVTs are silent 2. DVT often goes under-diagnosed as it is frequently asymptomatic. When symptoms do occur they are non-specific (pain in the calves or thigh muscles and swelling). Similar symptoms can occur with simple muscle strains or streptococcal infections. Often, a definitive diagnosis can only be reached when one of the following tests has been carried out 4 : 1) Venography. 2) Impedance phlethysmography. 3) Venous ultrasound. Silent VTE may develop into PE which itself may go unrecognized. PE is often asymptomatic and even when symptoms do appear they may be difficult to recognize 5. Consequently, less than half of all cases of fatal pulmonary embolism (PE) are detected prior to death 1. 1. Goldhaber SZ, Hennekens CH, Evans DA, Newton EC, Godleski JJ. Factors associated with correct antemortem diagnosis of major pulmonary embolism. American Journal of Medicine 1982;73:822-826. 2. Lethen H, Flachskampf FA, Schneider R, et al. Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. American Journal of Cardiology 1997;80:1066-1069. 3. Sandler DA, et al. J. Royal Soc. Med. 1989; 82:203-205. 4. Lensing AWA, Prandoni P, Prins MH et al. Deep vein thrombosis.