加速康复外科下骨科患者围手术期深静脉血栓形成的预防及管理新进展_West China Medical Journal

Authors：

段丹 ,  宁宁 , 李佩芳 , 张馨予 , 陈佳丽

四川大学华西医院骨科（成都 610041）;

Corresponding author：

宁宁, Email: gkningning@126.com

Keywords：

加速康复外科; 骨科; 围手术期; 深静脉血栓形成; 预防

DOI：

10.7507/1002-0179.201707142

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深静脉血栓形成是骨科术后患者常见并发症，其起病隐匿，不易察觉，往往在发病后才被发觉，易对患者造成较大危害。发生深静脉血栓形成后，其后遗症对患者的生活质量产生较大影响，甚至有可能引起致死性的肺栓塞。加速康复外科（enhanced recovery after surgery，ERAS）作为一种新的理念模式，被广泛应用于各类外科手术中，随着 ERAS 模式在骨科围手术期的广泛应用，患者术后可早期进食、早期下床活动、早期进行康复功能训练，可有效减少患者术后并发症的发生，缩短住院时间。该文从临床护理角度出发，为早期防治深静脉血栓，减少深静脉血栓形成，对 ERAS 下骨科患者围手术期深静脉血栓形成的危险因素、预防措施及管理进行研究分析，旨在对临床患者深静脉血栓形成的预防及护理提供参考依据，降低骨科围手术期患者术后深静脉血栓形成的发生率。

Citation： 段丹, 宁宁, 李佩芳, 张馨予, 陈佳丽. 加速康复外科下骨科患者围手术期深静脉血栓形成的预防及管理新进展. West China Medical Journal, 2017, 32(9): 1358-1361. doi: 10.7507/1002-0179.201707142 Copy

1.	Van Egmond JC, Verburg H, Mathijssen NM. The first 6 weeks of recovery after total knee arthroplasty with fast track. Acta Orthop, 2015, 86(6): 708-713.
2.	赵子涵. 快速康复外科理念在胰腺癌患者围手术期护理中的应用. 南京: 南京中医药大学, 2016.
3.	Ray WZ, Strom RG, Blackburn SL, et al. Incidence of deep venous thrombosis after subarachnoid hemorrhage. J Neurosurg, 2009, 110(5): 1010-1014.
4.	Khaldi A, Helo N, Schneck MJ, et al. Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg, 2011, 114(1): 40-46.
5.	张成, 兰红珍. 快速康复外科理念在预防老年患者人工髋关节置换术后下肢深静脉血栓形成护理中的应用. 中国老年保健医学, 2013, 11(3): 106-107.
6.	Kelly J, Rudd A, Lewis R, et al. Venous thromboembolism after acute stoke. Stroke, 2001, 32(1): 262-267.
7.	金玉娟, 谭丽萍, 柏慧华. 神经外科患者下肢深静脉血栓形成危险因素及预防的研究进展. 中华现代护理杂志, 2014, 20(34): 4406-4408.
8.	王宁科, 李晓声. 骨科关节置换术后深静脉血栓防治的研究进展. 医学临床研究, 2014, 31(3): 545-548.
9.	Yang SD, Liu H, Sun YP, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study. Sci Rep, 2015, 5: 11834.
10.	李春霞, 谢春雷, 李爱文, 等. 脑出血患者术后下肢深静脉血栓形成的相关因素分析及护理. 中华现代护理杂志, 2010, 16(35): 4233-4235.
11.	Yang SD, Ding WY, Yang DL, et al. Prevalence and risk factors of deep vein thrombosis in patients undergoing lumbar interbody fusion surgery: a single-center cross-sectional study. Medicine (Baltimore), 2015, 94(48): 2205-2211.
12.	Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 3-14.
13.	Nourian AA, Cunningham CM, Bagheri A, et al. Effect of anatomic variability and level of approach on perioperative vascular complications with anterior lumbar interbody fusion. Spine (Phila Pa 1976), 2016, 41(2): E73-E77.
14.	Paul M, Frank CT. Deep vein thrombosis. Surgery (Oxford), 2016, 34(4): 159-164.
15.	Di Nisio M, Van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet, 2016, 388(163): 3060-3073.
16.	倪惠, 王雪华, 邵凤慧. 骨科患者深静脉血栓防治与护理研究进展. 上海护理, 2014, 14(5): 69-72.
17.	林红, 陈晶, 李群, 等. 间歇气压疗法联合低分子肝素钙预防腰椎间盘突出症患者下肢静脉血栓形成的研究. 护理实践与研究, 2012, 9(21): 13-14.
18.	罗春梅, 冯诚诚, 缪丹, 等. 腰椎融合术后药物和物理方案预防静脉血栓栓塞症的效果比较. 创伤外科杂志, 2016, 18(11): 652-655.
19.	Yoshioka K, Murakami H, Demura S, et al. Prevalence and risk factors for development of venous thromboembolism after degenerative spinal surgery. Spine (Phila Pa 1976), 2015, 40(5): E301-E306.
20.	孙涛, 傅卫. 快速康复外科的现状与展望. 中国微创外科杂志, 2007, 7(6): 564-566.
21.	卿周明, 周雅裴, 张笔墨. 快速康复外科在老年髋关节术后预防下肢深静脉血栓中的应用. 中国保健营养, 2017, 27(12): 11.
22.	Zonca P, Stigler J, Maly T, et al. Do we really apply fast-track surgery? Bratisl Lek Listy, 2008, 109(2): 61-65.
23.	吕惠茹, 郭晓英, 陈静, 等. 早期护理干预对腰椎术后预防深静脉血栓的效果观察. 陕西医学杂志, 2014, 43(7): 934-934.
24.	Caldwell K, Prior SJ, Kampmann M, et al. Upper body exercise increases lower extremity venous blood flow in deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2013, 1(2): 126-133.
25.	李强, 李群, 全竹富, 等. 加速康复外科理念在胰体尾切除手术中的应用. 中国普通外科杂志, 2012, 21(9): 1144-1146.
26.	周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
27.	Mullaji A, Kanna R, Shetty GM, et al. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty:a prospective, randomized trial. J Arthroplasty, 2010, 25(6): 851-857.
28.	Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am, 2006, 88(5): 959-963.
29.	付丽敏, 杨冬蕊, 闫晶, 等. 加速康复外科理念对全膝关节置换术后并发症的影响. 承德医学院学报, 2014(4): 322-324.
30.	华政哲, 刘欣伟, 张敬东, 等. 加速康复外科理念在膝关节置换术围术期应用. 临床军医杂志, 2016, 44(10): 1022-1024.
31.	陈秀云, 刘研, 陈丽, 等. 骨科择期全麻手术术后禁水时间的研究. 中华现代护理杂志, 2010, 16(20): 2391-2393.
32.	李晓玲. 快速康复外科理念在预防经尿道前列腺切除术后下肢深静脉血栓形成护理中的应用. 护理与康复, 2010, 9(12): 1052-1053.
33.	Tousignant M, Boissy P, Moffet H, et al. Patients’ satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists’ satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial. Telemed J E Health, 2011, 17(5): 376-382.
34.	Kester BS, Merkow RP, Ju MH, et al. Effect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty. J Bone Joint Surg Am, 2014, 96(17): 1476-1484.

1. Van Egmond JC, Verburg H, Mathijssen NM. The first 6 weeks of recovery after total knee arthroplasty with fast track. Acta Orthop, 2015, 86(6): 708-713.
2. 赵子涵. 快速康复外科理念在胰腺癌患者围手术期护理中的应用. 南京: 南京中医药大学, 2016.
3. Ray WZ, Strom RG, Blackburn SL, et al. Incidence of deep venous thrombosis after subarachnoid hemorrhage. J Neurosurg, 2009, 110(5): 1010-1014.
4. Khaldi A, Helo N, Schneck MJ, et al. Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg, 2011, 114(1): 40-46.
5. 张成, 兰红珍. 快速康复外科理念在预防老年患者人工髋关节置换术后下肢深静脉血栓形成护理中的应用. 中国老年保健医学, 2013, 11(3): 106-107.
6. Kelly J, Rudd A, Lewis R, et al. Venous thromboembolism after acute stoke. Stroke, 2001, 32(1): 262-267.
7. 金玉娟, 谭丽萍, 柏慧华. 神经外科患者下肢深静脉血栓形成危险因素及预防的研究进展. 中华现代护理杂志, 2014, 20(34): 4406-4408.
8. 王宁科, 李晓声. 骨科关节置换术后深静脉血栓防治的研究进展. 医学临床研究, 2014, 31(3): 545-548.
9. Yang SD, Liu H, Sun YP, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study. Sci Rep, 2015, 5: 11834.
10. 李春霞, 谢春雷, 李爱文, 等. 脑出血患者术后下肢深静脉血栓形成的相关因素分析及护理. 中华现代护理杂志, 2010, 16(35): 4233-4235.
11. Yang SD, Ding WY, Yang DL, et al. Prevalence and risk factors of deep vein thrombosis in patients undergoing lumbar interbody fusion surgery: a single-center cross-sectional study. Medicine (Baltimore), 2015, 94(48): 2205-2211.
12. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 3-14.
13. Nourian AA, Cunningham CM, Bagheri A, et al. Effect of anatomic variability and level of approach on perioperative vascular complications with anterior lumbar interbody fusion. Spine (Phila Pa 1976), 2016, 41(2): E73-E77.
14. Paul M, Frank CT. Deep vein thrombosis. Surgery (Oxford), 2016, 34(4): 159-164.
15. Di Nisio M, Van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet, 2016, 388(163): 3060-3073.
16. 倪惠, 王雪华, 邵凤慧. 骨科患者深静脉血栓防治与护理研究进展. 上海护理, 2014, 14(5): 69-72.
17. 林红, 陈晶, 李群, 等. 间歇气压疗法联合低分子肝素钙预防腰椎间盘突出症患者下肢静脉血栓形成的研究. 护理实践与研究, 2012, 9(21): 13-14.
18. 罗春梅, 冯诚诚, 缪丹, 等. 腰椎融合术后药物和物理方案预防静脉血栓栓塞症的效果比较. 创伤外科杂志, 2016, 18(11): 652-655.
19. Yoshioka K, Murakami H, Demura S, et al. Prevalence and risk factors for development of venous thromboembolism after degenerative spinal surgery. Spine (Phila Pa 1976), 2015, 40(5): E301-E306.
20. 孙涛, 傅卫. 快速康复外科的现状与展望. 中国微创外科杂志, 2007, 7(6): 564-566.
21. 卿周明, 周雅裴, 张笔墨. 快速康复外科在老年髋关节术后预防下肢深静脉血栓中的应用. 中国保健营养, 2017, 27(12): 11.
22. Zonca P, Stigler J, Maly T, et al. Do we really apply fast-track surgery? Bratisl Lek Listy, 2008, 109(2): 61-65.
23. 吕惠茹, 郭晓英, 陈静, 等. 早期护理干预对腰椎术后预防深静脉血栓的效果观察. 陕西医学杂志, 2014, 43(7): 934-934.
24. Caldwell K, Prior SJ, Kampmann M, et al. Upper body exercise increases lower extremity venous blood flow in deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2013, 1(2): 126-133.
25. 李强, 李群, 全竹富, 等. 加速康复外科理念在胰体尾切除手术中的应用. 中国普通外科杂志, 2012, 21(9): 1144-1146.
26. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
27. Mullaji A, Kanna R, Shetty GM, et al. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty:a prospective, randomized trial. J Arthroplasty, 2010, 25(6): 851-857.
28. Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am, 2006, 88(5): 959-963.
29. 付丽敏, 杨冬蕊, 闫晶, 等. 加速康复外科理念对全膝关节置换术后并发症的影响. 承德医学院学报, 2014(4): 322-324.
30. 华政哲, 刘欣伟, 张敬东, 等. 加速康复外科理念在膝关节置换术围术期应用. 临床军医杂志, 2016, 44(10): 1022-1024.
31. 陈秀云, 刘研, 陈丽, 等. 骨科择期全麻手术术后禁水时间的研究. 中华现代护理杂志, 2010, 16(20): 2391-2393.
32. 李晓玲. 快速康复外科理念在预防经尿道前列腺切除术后下肢深静脉血栓形成护理中的应用. 护理与康复, 2010, 9(12): 1052-1053.
33. Tousignant M, Boissy P, Moffet H, et al. Patients’ satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists’ satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial. Telemed J E Health, 2011, 17(5): 376-382.
34. Kester BS, Merkow RP, Ju MH, et al. Effect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty. J Bone Joint Surg Am, 2014, 96(17): 1476-1484.

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加速康复外科下骨科患者围手术期深静脉血栓形成的预防及管理新进展

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