Alizadeh Kayvon, Hyman Neil
Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA.
Surg Technol Int. 2005;14:165-70.
Patients who undergo colorectal surgery are at a substantially higher risk for deep vein thrombosis (DVT) than their general surgery counterparts. The incidence of DVT in colorectal surgery patients who do not receive prophylaxis is approximately 30%; a four-fold increase exists in the incidence of pulmonary embolism. The precise reasons for the increased risk are uncertain; likely, contributing factors are the need for pelvic dissection, patient positioning (eg, use of stirrups), and indications for surgery (eg, inflammatory bowel disease, cancer). Despite the clear evidence that supports the safety and efficacy of DVT prophylaxis, appropriate preventive measures are frequently not used. Heparin preparations and mechanical compression in combination likely represents the most appropriate prophylactic regimen in these high-risk patients. Standard heparin appears to be as effective as low-molecular-weight heparin and considerably less costly. In the presence of relatively poor adherence to consensus guidelines for prophylaxis, critical pathways or electronic alerts may be useful to facilitate compliance with appropriate preventive measures.
接受结直肠手术的患者发生深静脉血栓形成（DVT）的风险比接受普通外科手术的患者高得多。未接受预防措施的结直肠手术患者中DVT的发生率约为30%；肺栓塞的发生率增加了四倍。风险增加的确切原因尚不确定；可能的促成因素包括盆腔解剖的需要、患者体位（如使用马镫）以及手术指征（如炎症性肠病、癌症）。尽管有明确证据支持DVT预防措施的安全性和有效性，但适当的预防措施却常常未被采用。肝素制剂与机械压迫联合使用可能是这些高危患者最合适的预防方案。普通肝素似乎与低分子肝素一样有效，而且成本要低得多。在对预防共识指南的依从性相对较差的情况下，关键路径或电子警报可能有助于促进对适当预防措施的遵守。
