Recent advances in venous thromboembolic prophylaxis during and after total hip replacement.
Recent advances in venous thromboembolic prophylaxis during and after total hip replacement.
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全髋关节置换术期间和术后静脉血栓栓塞预防的最新进展。
DOI：
10.2106/00004623-200002000-00010
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
G. Westrich
中科院分区：
文献类型：
--
作者：
E. Salvati;V. D. Pellegrini;N. Sharrock;P. Lotke;David W. Murray;H. Potter;G. Westrich
全髋关节置换术是一种特别容易出现血栓栓塞并发症并可能危及生命后果的手术。 Johnson 等人在 1962 年至 1973 年间进行的 7959 例全髋关节置换术中报告称，肺栓塞的总体患病率为 7.89%，致命性肺栓塞的患病率为 1.04%51,52。同样，1974 年，考文垂等人。据报道，在 2012 年连续进行的一系列全髋关节置换术中，肺栓塞的总体患病率为 2.2%16。在 62 名未接受预防性抗凝治疗的患者中，致命性肺栓塞的患病率为 3.4%。但平均手术时间为2.4小时，平均失血量为1650毫升，平均输血量为1144毫升。术后五天开始使用华法林进行预防性抗凝。患者平均卧床休息一周，然后才允许行走，术后平均三周出院17。
在过去的三十年中，对全髋关节置换术相关静脉血栓栓塞的病理生理学和预防的认识取得了实质性进展。据报道，在英国实施 1162 例全髋关节置换术后，在缺乏抗凝预防的情况下，采用现代手术技术发生致命性肺栓塞的发生率为 0.5%121。在北美，抗血栓栓塞预防和联合使用预捐自体血5、快速手术和早期活动似乎进一步将致命性肺栓塞发生率降低至 0.18% 或更低2,63,89,91,103,126。重要的是，人们越来越意识到凝血级联的强烈激活，这种激活发生在......
Total hip replacement is an operation that is particularly prone to thromboembolic complications with potentially life-threatening consequences. Johnson et al., in a series of 7959 total hip replacements performed between 1962 and 1973, reported that the overall prevalence of pulmonary embolism was 7.89 percent and that of fatal pulmonary embolism was 1.04 percent51,52. Similarly, in 1974, Coventry et al. reported an overall prevalence of pulmonary embolism of 2.2 percent in a series of 2012 consecutive total hip replacements16. In a subset of sixty-two patients who had received no prophylactic anticoagulation, the prevalence of fatal pulmonary embolism was 3.4 percent. However, the average duration of the operation was 2.4 hours, the average blood loss was 1650 milliliters, and the average volume of blood transfused was 1144 milliliters. Prophylactic anticoagulation with warfarin was started five days after the operation. Patients were managed with bed rest for an average of one week before walking was allowed, and they were discharged at an average of three weeks after the operation17.
During the last three decades, substantial advances have been made in the understanding of the pathophysiology and the prevention of venous thromboembolism associated with total hip replacement. The prevalence of fatal pulmonary embolism with contemporary operative techniques in the absence of anticoagulant prophylaxis was reported to be 0.5 percent after 1162 total hip replacements performed in the United Kingdom121. In North America, antithromboembolic prophylaxis and the combined use of predonated autologous blood5, an expeditious operation, and early mobilization appear to have lowered the rate of fatal pulmonary embolism even further, to 0.18 percent or less2,63,89,91,103,126. Importantly, an increased awareness of the intense activation of the clotting cascade, which occurs during …
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