- 期刊
骨科大手術──靜脈血栓栓塞之預防
Prophylaxis for VTE among Major Orthopedic Surgical Patients
摘要
目的：骨科大手術後可能會發生靜脈血栓栓塞(VTE)的併發症。美國胸腔醫師學會(ACCP)依據實證醫學提出抗血栓治療和預防血栓形成的臨床實踐準則。根據此準則，進行髖關節全關節置換術(THA)及膝關節全關節置換術(TKA)患者於術後應使用抗血栓藥物或機械式加壓法來預防VTE的發生。本研究旨在檢視本院進行骨科大手術之病人，其預防VTE的實際情形。方法：本研究收集某醫院自2014年11月至2015年10月期間進行THA和TKA的病人。收集病人資料包括入／出院日期、手術日期、抗血栓藥物種類和劑量、使用抗血栓藥物開始和結束日期，以及術後是否有被診斷出VTE。結果：本研究共收案138人次，其中進行THA和TKA分別為39及99人次，沒有病人在手術後被診斷出VTE。進行THA的病人中，只有一例原本就在服用aspirin，其於手術前一天停止服用aspirin，並於手術後隔天又再度開始服用aspirin；其餘者皆無給予預防VTE的用藥。進行TKA的病人中，有53人次使用抗血栓藥物來預防VTE，其中11人次原本就持續在服用aspirin，另外42人次於術後隔天即開始服用抗血栓藥物，使用的藥物只有一例是rivaroxaban，其餘者皆是使用aspirin。本研究也發現使用抗血栓藥物的天數，有33%的病人並不符合ACCP準則。結論：期望把VTE預防措施導入常規治療，以減低病人發生VTE之風險。
並列摘要
Objective: VTE complications may happen to patients undergoing major orthopedic surgery. According to the evidence-based Clinical Practice Guidelines of Antithrombotic Therapy and Prevention of Thrombosis published by American College of Chest Physicians (ACCP), VTE can be prevented by performing anticoagulant therapy or mechanical compression thromboprophylaxis on patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aim of this study is to investigate application of VTE prophylaxis among major orthopedic surgical patients in our hospital. Methods: A chart review was conducted, including patients hospitalized for THA and TKA from November 2014 to October 2015. The information collected included admission date, discharge date, operation date, names and dosage of antithrombotic agents, start/end dates of antithrombotic agents used, and whether VTE was diagnosed. Results: A total of 138 patients were included (39 THA and 99 TKA). No patient developed VTE after surgery. Among patients undergoing THA, only one patient received VTE prophylaxis (this patient took aspirin regularly before surgery, discontinued on the day of surgery, and resumed on the following day) while the others did not. Among patients undergoing TKA, 53 took anticoagulant agents as VTE prophylaxis, of which 11 patients took aspirin before and after surgery, 41 took aspirin only after surgery, and 1 took rivaroxaben after surgery. Regarding the duration of anticoagulants, it is found that 33% did not meet ACCP Guidelines requirements. Conclusion: We hope VTE prophylaxis can be adopted as a regular treatment to reduce the risk of VTE associated with major orthopedic surgery.
延伸閱讀
- Shen, T. C. (2005). 肱動脈結紮及徹底清創：簡易且安全的嚴重上肢血管通路感染之治療. 慈濟醫學雜誌, 17(3), 159-162. https://doi.org/10.6440/TZUCMJ.200506.0159
- Chang, Y. C., Hung, C. R., Lin, Y. H., Lin, Y. C., & Liao, T. F. (2017). 使用派普萊栓塞裝置進行因支架內血栓形成之經動脈治療術－病例報告. 中華放射線技術學雜誌, 41(2), 92-96. https://www.airitilibrary.com/Article/Detail?DocID=16849418-201706-201707250010-201707250010-92-96
- 包玉綢、高佳霙、余幸澄、何鴻鋆、謝育整（2005）。降低經皮穿腔冠狀動脈血管成形術後瘀青發生率。榮總護理，22(2)，117-124。https://doi.org/10.6142/VGHN.22.2.117
- Lin, W. C., Chen, Y. F., Lin, C. H., Ho, Y. J., Tzeng, Y. H., Chiang, H. J., Chang, C. H., Cheng, Y. C., Shen, W. C., & Chen, J. H. (2009). Reappraisal of the Management and Outcome of Emphysematous Pyelonephritis. The Kaohsiung Journal of Medical Sciences, 25(1), 16-24. https://www.airitilibrary.com/Article/Detail?DocID=1607551X-200901-25-1-16-24-a
- Lee, Y. L. (2013). The effects of antibiotic prophylaxis for patients with esophageal variceal bleeding [master's thesis, Chung Shan Medical University]. Airiti Library. https://doi.org/10.6834/CSMU.2013.00108