应用低分子肝素预防骨科术后DVT的合理性评价

Evaluation of Postoperative DVT Prevention by LMWH

关键词:  深静脉血栓  低分子肝素  药物预防  合理性评价  骨科手术

Key words:  deep venous thrombosis  low molecule weight heparin  drug prophylaxis  rationality evaluate  orthopedics surgery

摘要:

目的 对天津医院一段时间内应用低分子肝素进行术后深静脉血栓形成(deep vein thrombosis，DVT)预防的合理性进行分析评价。方法 收集1年内骨科手术病例，根据不同手术类型，将其分为关节置换术、复位内固定术、创伤后脊柱修复术，分别统计其低分子肝素的使用率、给药时间、使用疗程、预防效果。结果 术后低分子肝素的使用率为84.0%，创伤后脊柱修复术的使用率为58.5%，低于平均水平。关节置换术、内固定术、创伤后脊柱修复术的术前12 h内给药率分别为7.5%，33.3%，0%，术后12 h内全量给药率分别为87.5%，31.6%，8.3%。关节置换术与内固定术的给药疗程最长超过35 d，预防后DVT发生率为12.4%。结论 临床采用药物预防时，给药时间和疗程常不能按指南执行。这是药物预防无法到达预期效果，术后DVT的发生率仍较高的重要原因。

Abstract:

OBJECTIVE To evaluate the rationality of the postoperative DVT prevention with the application of low molecular weight heparin over a period of time. METHODS Cases were collected with orthopedics surgery within a year, divided them into joint replacement, internal fixation and post-traumatic spinal prosthesis. Statistics was done according to the use of LMWH, delivery time, course of treatment and prevention effect. RESULTS Utilization rate of LMWH was 84.0%, post-traumatic spinal prosthesis was 58.5% which was below the average. Preoperative 12 h dosing rate of joint replacement, internal fixation and spina repairation were 7.5%, 33.3% and 0%, respectively. Whole quantity dosing rate 12 h after operation were 87.5%, 31.6%, 8.3%, respectively. Between joint replacement and internal fixation, the course of drug treatment was more than 35 d, the incidence of DVT was 12.4%. CONCLUSION The utilization of LMWH can’t follow the guidelines. This is an important reason why the incidence of postoperative DVT is still high in drug prevention.