中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
8期
3315-3319
,共5页
静脉血栓形成%静脉血栓栓塞%肺栓塞%脊柱外科手术
靜脈血栓形成%靜脈血栓栓塞%肺栓塞%脊柱外科手術
정맥혈전형성%정맥혈전전새%폐전새%척주외과수술
Venous thrombosis%Venous thromboembolism%Pulmonary embolism%Spine surgery
目的分析脊柱手术后静脉血栓栓塞症（ VTE）的自然发生率，探讨采取干预措施抗凝以预防VTE的必要性；结合文献，分析 VTE 的发生与手术方式、体位、时间等关系，指导临床改进相关环节。方法2011年1月至2012年1月收治的接受脊柱手术患者168例，术前进行血常规、凝血指标及双下肢静脉彩超检查。术后复查双下肢静脉彩超。随访时间3个月。如果彩超怀疑深静脉血栓（ DVT），行下肢静脉造影确诊；如果高度怀疑肺栓塞（ PE）形成，行肺血管造影确诊。统计患者资料及VTE例数。通过SPSS 11.0软件，利用χ2检验、Mann-Whitney检验分析。结果168例患者中确诊VTE 1例，无PE病例。脊柱手术后VTE自然发生率为0.60％。尝试分析VTE阳性组与阴性组在性别、年龄、体重、手术时间、部位、入路、失血量、卧床时间等方面是否存在统计学差异。但由于VTE阳性例数少，随机性大，未能进行分析。结论本次研究结果与文献报道类似，显示脊柱手术围手术期不采用抗凝措施下，VTE自然发生率较低；脊柱手术后对于无VTE症状以及不存在VTE危险因素的患者不需要行双下肢静脉彩超检查、血管造影检查以及常规抗凝处理。
目的分析脊柱手術後靜脈血栓栓塞癥（ VTE）的自然髮生率，探討採取榦預措施抗凝以預防VTE的必要性；結閤文獻，分析 VTE 的髮生與手術方式、體位、時間等關繫，指導臨床改進相關環節。方法2011年1月至2012年1月收治的接受脊柱手術患者168例，術前進行血常規、凝血指標及雙下肢靜脈綵超檢查。術後複查雙下肢靜脈綵超。隨訪時間3箇月。如果綵超懷疑深靜脈血栓（ DVT），行下肢靜脈造影確診；如果高度懷疑肺栓塞（ PE）形成，行肺血管造影確診。統計患者資料及VTE例數。通過SPSS 11.0軟件，利用χ2檢驗、Mann-Whitney檢驗分析。結果168例患者中確診VTE 1例，無PE病例。脊柱手術後VTE自然髮生率為0.60％。嘗試分析VTE暘性組與陰性組在性彆、年齡、體重、手術時間、部位、入路、失血量、臥床時間等方麵是否存在統計學差異。但由于VTE暘性例數少，隨機性大，未能進行分析。結論本次研究結果與文獻報道類似，顯示脊柱手術圍手術期不採用抗凝措施下，VTE自然髮生率較低；脊柱手術後對于無VTE癥狀以及不存在VTE危險因素的患者不需要行雙下肢靜脈綵超檢查、血管造影檢查以及常規抗凝處理。
목적분석척주수술후정맥혈전전새증（ VTE）적자연발생솔，탐토채취간예조시항응이예방VTE적필요성；결합문헌，분석 VTE 적발생여수술방식、체위、시간등관계，지도림상개진상관배절。방법2011년1월지2012년1월수치적접수척주수술환자168례，술전진행혈상규、응혈지표급쌍하지정맥채초검사。술후복사쌍하지정맥채초。수방시간3개월。여과채초부의심정맥혈전（ DVT），행하지정맥조영학진；여과고도부의폐전새（ PE）형성，행폐혈관조영학진。통계환자자료급VTE례수。통과SPSS 11.0연건，이용χ2검험、Mann-Whitney검험분석。결과168례환자중학진VTE 1례，무PE병례。척주수술후VTE자연발생솔위0.60％。상시분석VTE양성조여음성조재성별、년령、체중、수술시간、부위、입로、실혈량、와상시간등방면시부존재통계학차이。단유우VTE양성례수소，수궤성대，미능진행분석。결론본차연구결과여문헌보도유사，현시척주수술위수술기불채용항응조시하，VTE자연발생솔교저；척주수술후대우무VTE증상이급불존재VTE위험인소적환자불수요행쌍하지정맥채초검사、혈관조영검사이급상규항응처리。
Objective Through the prospective clinical study , to demonstrate the prevalence of venous thromboembolism ( VTE) after spinal surgery and if there′s necessary for routine prophylaxis .Compare with that in the published studies to determine the relationship between VTE and operation method ,time,position ect and to guide the improvement .Methods 168 patients who underwent spine surgery from Jan ,2011 to Jan,2012 were included in this study.All patients had a standard laboratory screening that included a complete blood count ,a coagulation profile and were examined with color Doppler ultrasound before surgery .Reexamined with color Doppler ultrasound in both lower extremities after surgery .Follow-up visit lasts three months .If color Doppler ultrasound shows deep venous thrombosis (DVT),double lower limb venography was use to ensure DVT .If doubt pulmonary embolism(PE)highly,pulmonary angiography was used .Collect the number of VTE .χ2 test and Mann-Whitney test was used .Results Among 168 patients,there was no PE case.Only one patient was made a definite diagnosis as DVT .In this study,the incidence of thromboembolism complications after spinal surgery was 0.60%.Planning to analysis VTE positive group and negative group in age, gender, weight, operation time, site access, blood loss, in bed time whether there were statistically significant differences .Conclusions The study as similar as literatures shows the incidence of VTE after spinal surgery is low.We recommend that,no antithrombotic prophylaxis,no color Doppler ultrasound in both lower extremities and no angiography after spine surgery if there is no symptom of VTE and no risk factors of VTE .
