Thrombosis risk assessment as a guide to quality patient care
Thrombosis risk assessment as a guide to quality patient care
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DOI：
10.1016/j.disamonth.2005.02.003
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发表时间：
2005-02-01
影响因子：
4
通讯作者：
Caprini, JA
中科院分区：
文献类型：
--
作者：
Caprini, JA
静脉血栓栓塞症（VTE）是内科和外科实践中经常遇到的严重并发症。每年大约有200万人将遭受深静脉血栓形成（DVT），并且这些个体中的大约60万人将遭受肺栓塞（PE），肺栓塞每年在大约20万患者中是致命的。1肺动脉高压预计会在大约30，000例PE存活的患者中发生。血栓后综合征（PTS）在美国每年约有800，000例患者，其中7%的人会有严重的问题，并成为永久性残疾。2最令人不安的统计数据之一是，每年200万例DVT病例中有50%是“沉默的”。有时，疾病的第一个体征或症状是致命的PE。3此外，据估计，如果没有接受适当的血栓形成预防，20名住院医疗患者中约有1名将发生致命性PE。DVT的另一个严重并发症是非出血性卒中，可能发生在卵圆孔未闭的患者中。5腿部深静脉系统中的凝块会破裂并移动到右心房，扩张心脏腔室。如果患者是25%或30%的无功能卵圆孔未闭患者之一，这种心房扩张可以打开未闭孔并允许凝块进入心脏左侧并进入大脑，从而产生中风。6这个问题的诊断很困难，因为一旦右心房恢复正常大小，卵圆孔未闭可能很难被发现。通常，当血块从腿部脱落时，它会干净地脱落，而不会有残留损伤，这些损伤可以在随后的双重检查中检测到。6
Venous thromboembolism (VTE) is a serious complication that is frequently encountered in medical and surgical practice. Approximately 2 million people each year will suffer from a deep vein thrombosis (DVT), and approximately 600,000 of these individuals will suffer a pulmonary embolism (PE), which is fatal in about 200,000 patients annually. 1 Pulmonary hypertension can be expected to develop in approximately 30,000 patients who survive their PE. The postthrombotic syndrome (PTS) will be seen in approximately 800,000 patients annually in the United States; 7% of these individuals will have a severe form of the problem and become permanently disabled. 2 One of the most troubling statistics is the fact that 50% of the 2 million cases of DVT yearly are “silent.” Occasionally, the first sign or symptom of the disease is a fatal PE. 3 Furthermore, it has been estimated that approximately 1 of 20 hospitalized medical patients will suffer a fatal PE if they have not received appropriate thrombosis prophylaxis. 4Another serious complication of DVT is nonhemorrhagic stroke that may occur in a patient with a patent foramen ovale. 5 A clot in the deep venous system of the leg can break off and travel to the right atrium, dilating that heart chamber. If the patient is one of the 25 or 30% who have a nonfunctioning patent foramen ovale, this atrial dilatation can open the patent foramen and allow the clot to enter the left side of the heart and proceed to the brain, producing a stroke. 6 The diagnosis of this problem is difficult because once the right atrium returns to normal size, the patent foramen ovale may be difficult to detect. Often when the clot breaks off from the leg, it does so cleanly without residual damage that can be detected on subsequent duplex examination. 6