创伤后急性大出血患者围手术期新发静脉血栓的药学监护

Pharmaceutical care of a patient with newly developed venous thrombosis during the perioperative period of acute massive hemorrhage after trauma

关键词:  抗凝治疗  深静脉血栓形成  活动性出血  围手术期处理  风险因素

Key words:  anticoagulant therapy  deep vein thrombosis  active bleeding  perioperative management  risk factors

摘要:

本文报道1例多发伤骨折合并肾挫伤患者围手术期新发VTE的抗凝治疗过程，探讨创伤后急性大出血合并VTE高危患者围术期的全程化抗凝管理。以抗凝为切入点，通过密切关注患者血栓和出血症状及凝血功能指标，及时制定和优化VTE预防到VTE形成后的抗凝治疗方案，从而控制血栓进展且最大程度避免出血加重，患者治疗期间未发生不可控制的出血事件。本文剖析创伤后急性大出血合并VTE高危患者围手术期VTE的危险因素，为创伤患者VTE防治的抗凝治疗方案提供参考。

Abstract:

This article reports the anticoagulant treatment process of a patient with multiple trauma fracture and renal contusion during the perioperative period. To investigate the perioperative anticoagulation management in patients with acute massive hemorrhage after trauma and high risk of VTE. From the prevention of VTE to the formulation and optimization of anticoagulant therapy after the formation of VTE, on the premise of ensuring effective treatment, taking anticoagulation as the entry point, closely monitoring coagulation function indicators, controlling the progress of thrombosis, and avoiding the aggravation of bleeding to the greatest extent. No uncontrollable bleeding events occurred during the treatment. This article deeply analyzes the risk factors of perioperative VTE in patients with acute massive hemorrhage after trauma and high risk of VTE, summarizes the treatment experience, and provides a reference for the prevention and treatment of VTE in trauma patients, and also provides lessons and warnings for better improvement of treatment plans.