外科手术VYE预防和治疗进展.pptVIP

Competing Interests Declared: None. This article is part of a group of articles from the Patient Safety in Surgery Study, a demonstration project between the Department of Veterans Affairs National Surgical Quality Improvement Program and the American College of Surgeons in selected private-sector hospitals, funded by the Agency for Healthcare Research and Quality, grant number 5U18HS011913, entitled “Reporting System to Improve Patient Safety in Surgery.” The Patient Safety in Surgery Study led to the successful formation of the American College of Surgeons National Surgical Quality Improvement Program. This article represents the personal viewpoints of the authors and cannot be construed as a statement of official policy of the American College of Surgeons, the Department of Veterans Affairs, or the US government. * 危险 * 北京大学第一医院 * 北京大学第一医院 * 20-30 cc of blood moved each compression cycle Current methods of thromboprophylaxis * Nurmohamed et al. conducted a meta-analysis of all studies conducted between 1984 and 1991 comparing LMWH and UFH for the prevention of VTE in patients undergoing general surgery (defined as abdominothoracic or gynaecological surgery) and patients undergoing orthopaedic surgery (defined as elective or traumatic hip surgery). For each report the relative risk (RR) and the 95% confidence interval were calculated for the efficacy and safety of LMWH over UFH treatment. Major bleeding was defined as clinically overt bleeding with one or more of the following criteria: fall in haemoglobin of more than 1.2 g/L; bleeding necessitating re-operation or cessation of prophylaxis; or retroperitoneal or intracranial bleeding). In patients undergoing orthopaedic surgery there was a reduction in risk of DVT and PE in those receiving LMWH compared with those receiving UFH without an increase in the risk of major bleeding For DVT the RR was 0.68 (95% CI: 0.54 to 0.86) For PE the RR was 0.43 (95% CI: 0.22 to 0.82) For major bleeding the RR was 0.75 (95% CI: