静脉血栓栓塞的防治课件.pptx
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- 关 键 词:
- 静脉 血栓 栓塞 防治 课件
- 资源描述:
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1、2016.12According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplineAccording to the assessment requirements of party conduct and clean government,combined wi
2、th the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline预防在先 加强评估 及时处理According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders
3、 integrity and self-discipline1.认识不足,重视不够 2.缺乏系统的医护一体的防治体系3.防治措施落实不到位,设备配备不足4.缺乏系统的评估流程According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline统一认识培训制定评估
4、流程落实预防措施监督检查改进制度According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline 防治 措 施VTE概念及流行病学评 估 方 法1 13 32 2 VTE的形成原因4 4According to the assessment requirem
5、ents of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline静脉静脉血栓血栓栓塞栓塞(VTEVTE)是是指血液在指血液在静脉静脉内不正常地凝结,内不正常地凝结,阻塞管腔所致静脉回流障碍性疾阻塞管腔所致静脉回流障碍性疾病。可发生于全身各部位静脉,病。可发生于全身各部位静脉,以下肢深静脉为多以下肢深静脉为多 深静脉深静脉血栓血栓
6、DVTDVT是是指血液在指血液在深静脉深静脉内不正常地凝内不正常地凝结,阻塞管腔所致静脉回流障碍结,阻塞管腔所致静脉回流障碍性疾病。可发生于全身各部位静性疾病。可发生于全身各部位静脉,以下肢深静脉为多脉,以下肢深静脉为多 肺栓塞肺栓塞PEPE指来自静脉系统或右心的血栓阻塞指来自静脉系统或右心的血栓阻塞肺动脉或其分支肺动脉或其分支所致的肺循环功能所致的肺循环功能障碍性疾病。障碍性疾病。DVT、PE是同一种疾病VET在不同部位、不同阶段两种临床表现形式According to the assessment requirements of party conduct and clean govern
7、ment,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplineVTE:Venous Thrombus EmbolismDVT:Deep Venous ThrombosisPE:Pulmonary EmbolismSVT:Superficial Cenous Thrombosis (浅静脉血栓)According to the assessment requirements of party condu
8、ct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline普通人群中发病率:5/10,00050岁0.5%75岁4.5%年龄:每增加10岁,发病率翻倍 骨科手术:4080%普外科手术:2040%血管外科手术(腹主动脉、下肢动脉):1832%妇产科、神经外科、神经内科等均高发According to the assessment requirements of
9、party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline2VTE的形成原因According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requi
10、rements of state-owned Enterprise leaders integrity and self-discipline静脉血静脉血流滞缓流滞缓 手术中脊髓麻醉或全身麻醉导致周围静脉扩张、静脉手术中脊髓麻醉或全身麻醉导致周围静脉扩张、静脉流速减慢;手术中由于麻醉作用致使下肢肌肉完全麻流速减慢;手术中由于麻醉作用致使下肢肌肉完全麻痹,失去了收缩功能,术后又因切口疼痛和其他原因痹,失去了收缩功能,术后又因切口疼痛和其他原因如患者卧床休息,下肢肌肉处于松弛状态,致使血流如患者卧床休息,下肢肌肉处于松弛状态,致使血流滞缓,而其可能是滞缓,而其可能是DVT的的首要因素首要因素 静脉
11、壁静脉壁的损伤的损伤 a化学性损伤、化学性损伤、b机械性损伤机械性损伤 c感染性损伤感染性损伤 血液高血液高凝状态凝状态 是引起静脉血栓的是引起静脉血栓的基本因素基本因素之一,各种大型手术可引起高之一,各种大型手术可引起高凝状和血小板黏聚能力增强;术后,血清前纤维蛋白溶酶凝状和血小板黏聚能力增强;术后,血清前纤维蛋白溶酶活化剂和纤维蛋白溶酶二者的抑制剂水平均升高,从而使活化剂和纤维蛋白溶酶二者的抑制剂水平均升高,从而使纤维蛋白溶解减少。而开放性创伤患者大剂量应用止血药纤维蛋白溶解减少。而开放性创伤患者大剂量应用止血药物止血,也可使血液呈高凝状态。物止血,也可使血液呈高凝状态。静脉血流滞缓和血液
12、高凝状态是两个主要原因。常常是2个或3个因素的综合作用而造成DVT According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline3评估方法According to the assessment requirements of party conduct
13、and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline设计者设计者名称名称适用对象适用对象美国西北大学学者CapriniCaprini血栓评估工具住院患者英格兰学者AutarAutarDVT评分表住院患者意大利帕多瓦大学血栓栓塞中心BarbarPadua风险评估工具内科住院患者密歇根大学医学中心和辛辛那提大学医学中心RAP风险评分工具创伤患者加拿大学者Wells
14、Wells DVT评分法门诊患者According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline危险因素(每项危险因素(每项1 1分)分)危险因素(每项危险因素(每项2 2分)分)危险因素(每项危险因素(每项3 3分)分)危险因素(每项危险因素(每项5 5分
15、)分)年龄年龄41604160岁岁oo 肺功能异常肺功能异常oo年龄年龄 61746174岁岁oo 年龄年龄7575岁岁oo 脑卒中(脑卒中(1 1个月内)个月内)oo小手术(小手术(3030分钟)分钟)oo 急性心肌梗塞急性心肌梗塞oo 关节镜手术关节镜手术oo VTE VTE病史病史oo 择期关节置换术择期关节置换术oo BMT BMT25Kg/25Kg/oo 充血性心力衰竭(充血性心力衰竭(1 1个月内)个月内)oo 大型开放手术(大型开放手术(45min45min)oo VTE VTE家族史家族史oo 髋关节、骨盆或下肢髋关节、骨盆或下肢骨折骨折oo 下肢水肿下肢水肿oo 肠炎病史肠炎
16、病史oo 腹腔镜手术(腹腔镜手术(45min45min)oo 因子因子V LeidenV Leiden阳性阳性oo 急性脊髓损伤(急性脊髓损伤(1 1个个月内)月内)oo 静脉曲张静脉曲张oo 需要卧床休息的内科需要卧床休息的内科患者患者oo 恶性肿瘤恶性肿瘤oo 凝血酶原凝血酶原20210A20210A阳性阳性oo 妊娠期或产后妊娠期或产后 oo 卧床或制动(卧床或制动(72h72h)oo 狼疮抗凝物阳性狼疮抗凝物阳性oo 不能解释或二次自然不能解释或二次自然流产史流产史 oo 石膏固定石膏固定oo 抗心磷脂抗体阳性抗心磷脂抗体阳性oo 口服避孕药或激素替口服避孕药或激素替代治疗代治疗 oo
17、 中央静脉置管中央静脉置管oo 血清同型半胱氨酸升血清同型半胱氨酸升高高oo 败血症(败血症(1 1个月内)个月内)oo 肝素诱导的血小板减肝素诱导的血小板减少症少症oo 严重肺部疾病,包括严重肺部疾病,包括肺炎(肺炎(1 1个月内)个月内)oo 其他先天性或获得性其他先天性或获得性易栓症易栓症According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-own
18、ed Enterprise leaders integrity and self-discipline4防治措施According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline 基本预防 物理预防 药物预防 According to the assessme
19、nt requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline评分及风险分级评分及风险分级DVT DVT 发发 生生 率率(%)建议预防措施建议预防措施0-1(低危)10无需特殊处理:尽早活动2(中危)10-20预防措施:基本预防或物理预防或药物预防;基本预防:告知风险;健康宣教(戒烟、多饮水、控糖、降脂
20、等);下肢无血栓形成可做下肢被动、主动活动:卧床、麻醉未醒按摩下肢腓肠肌,10-30分/次,6-8次/d;术后清醒做足踝背伸柘曲每次10秒*10次1组,q1h或8组/d;足踝关节内外翻、旋转;物理预防:穿抗血栓弹力袜或充气压力泵30分/次,2-4次/d;药物预防:遵医嘱应用抗凝药物3-4(高危)20-40预防措施:基本预防+物理预防+药物预防5(极高危)40-80基本预防+物理预防+药物预防+实施三级高危随访监控According to the assessment requirements of party conduct and clean government,combined with
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