Browd Samuel R, Ragel Brian T, Davis Gary E, Scott Amy M, Skalabrin Elaine J, Couldwell William T
Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132-2303, USA.
Neurosurg Focus. 2004 Oct 15;17(4):E1. doi: 10.3171/foc.2004.17.4.1.
The incidence of deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) in patients undergoing neurosurgery has been reported to be as high as 25%, with a mortality rate from PE between 9 and 50%. Even with the use of pneumatic compression devices, the incidence of DVT has been reported to be 32% in these patients, making prophylactic heparin therapy desirable. Both unfractionated and low-molecular-weight heparin have been shown to reduce the incidence of DVT consistently by 40 to 50% in neurosurgical patients. The baseline rate for major intracranial hemorrhage (ICH) following craniotomy has been reported to be between 1 and 3.9%, but after initiation of heparin therapy this rate has been found to be as high as 10.9%. Therefore, neurosurgeons must balance the risk of PE against the increased risk of postoperative ICH from prophylactic heparin for DVT. The authors review the literature on the incidence of DVT and PE in neurosurgical patients, focusing on the incidence of ICH related to the use of unfractionated and low-molecular-weight heparin in this patient population.
据报道，接受神经外科手术的患者发生深静脉血栓形成（DVT）及随后发生肺栓塞（PE）的发生率高达25%，PE导致的死亡率在9%至50%之间。即便使用了气动压迫装置，据报道这些患者中DVT的发生率仍为32%，因此预防性肝素治疗是可取的。普通肝素和低分子量肝素均已被证明能使神经外科手术患者的DVT发生率持续降低40%至50%。据报道，开颅术后严重颅内出血（ICH）的基线发生率在1%至3.9%之间，但在开始肝素治疗后，这一发生率高达10.9%。因此，神经外科医生必须权衡PE的风险与预防性肝素治疗DVT导致术后ICH风险增加之间的利弊。作者回顾了关于神经外科手术患者DVT和PE发生率的文献，重点关注该患者群体中与使用普通肝素和低分子量肝素相关的ICH发生率。
