骨科大手术后静脉血栓症预防.pptVIP

* 肝素与PF4结合形成复合体，此复合体再会结合IgG形成了HIT抗体，HIT抗体通过IgG与血小板相结合，从而造成了血小板与血小板之间的聚集。由此引起血小板减少症以及血栓形成。 * * Postthrombotic syndrome(PTS):血栓后综合征 * * * 1856年，维科(Virchow)把预测血栓形成的因素假想成一个三角。Virchow’s三角描述了促进血栓形成的三个病理因素： 血管壁异常（内皮损伤） 血流异常（循环淤滞） 凝血因子异常（高凝状态） 不同的危险因素不同程度地导致VTE的发生。 In 1856, Virchow postulated a triad of conditions that predispose to thrombus formation.1 Virchow’s triad describes three abnormalities that promote thrombus formation:2 abnormalities in the blood vessel wall (endothelial injury) abnormalities in blood flow (circulatory stasis) abnormalities in blood clotting components (hypercoagulable state). Various risk factors contribute to a different extent to the development of VTE. References 1. Virchow R, ed. Gesammelte Abhandlungun zur Wissenschaftichen Medicin. Von Meidinger Sohn, Frankfurt, 1856. 2. Blann AD, Lip GYH. BMJ 2006;332:215–19. * 行骨科大手术的患者面临着血栓栓塞症发生风险的增加，因为骨科手术影响着维柯氏三角的所有三方面因素。 手术过程中导致血管壁损伤； 手术本身导致的血流阻断； 手术中因麻醉、不活动和使用止血带以及术后不活动导致的静脉淤滞 大面积的组织损伤会导致凝血系统的改变 Patients undergoing major orthopaedic surgery are exposed to conditions that increase the risk of thromboembolic complications, affecting all three parts of Virchow’s triad:1,2,3 damage to the blood vessel wall during the operation obstruction of blood flow caused by surgery venous stasis caused by anaesthesia, immobility and tourniquet use during surgery, and immobility during the postoperative recovery period changes to the coagulation system resulting from extensive tissue damage. References 1. Blann AD, Lip GYH. BMJ 2006;332:215–19. 2. Anderson DR et al. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 1998. 3. Roderick P et al. Health Technol Assess 2005;9:iii–iv, i–x, 1–78. * This slide describes in more detail the factors that promote thrombus formation in patients undergoing major orthopaedic surgery. * The American College of Chest Physicians (ACCP) has identified three risk levels for VTE to which surgical patients can be assigned. This classification syste