Sing Ronald F, Camp Steven M, Heniford B Todd, Rutherford Edmund J, Dix Stephanie, Reilly Patrick M, Holmes James H, Haut Elliott, Hayanga Awori
Department of Surgery, FH Sammy Ross Jr. Trauma Center, Charlotte, NC 28203, USA.
J Trauma. 2006 Apr;60(4):732-4; discussion 734-5. doi: 10.1097/01.ta.0000210285.22571.66.
Four recent reports of the retrieval of optional vena cava filters (VCF) in trauma patients had average implant durations of 10, 19, and 19 days (one not specified). Two patients in these studies had pulmonary emboli after VCF removal. No evidence-based guidelines exist on the appropriate time to remove optional VCF. The purpose of this study was to examine the timing of pulmonary emboli (PE) and determine the optimal time to remove optional VCFs.
A multicenter retrospective chart review of trauma patients who had a postinjury PE between January 2001 and December 2004 was performed. We examined the demographics, prophylaxis at the time of PE (pharmacologic [unfractionated or low molecular weight heparin] or sequential compression devices [SCD]), diagnostic test used, timing of PE from the date of injury, and survival outcome.
In all, 146 patients were identified, mean age 45.1 (+/- 21.1 SD); Injury Severity Score 18.0 (+/- 12.1 SD). Diagnosis was obtained by spiral computed tomography (N = 93), pulmonary arteriogram (N = 18), V/Q (N = 26), autopsy (N = 6), clinical (N = 6), and unknown (N = 3). Overall mortality was 17.8% (N = 26). Pulmonary embolism was felt to contribute to or was the cause of death in 85% (N = 22) of these patients. Two late PE deaths occurred (days 21 and 43). Sixty (37%) patients had pharmacologic prophylaxis at the time of PE and 83 (50.9%) had SCDs. Average time from injury to PE was 7.9 days (+/- 8.1 SD), the longest being 43 days postinjury. Eleven percent of PE occurred after 21 days, including fatal PE.
Clinical criteria defining the time to remove optional VCFs without exposing patients to the risk of PE by removing a filter too soon should be determined.
最近有四份关于创伤患者取出临时性下腔静脉滤器（VCF）的报告，滤器平均植入时间分别为10天、19天和19天（有一份未注明）。这些研究中有两名患者在取出VCF后发生了肺栓塞。目前尚无关于取出临时性VCF的合适时机的循证指南。本研究的目的是研究肺栓塞（PE）的发生时间，并确定取出临时性VCF的最佳时机。
对2001年1月至2004年12月期间发生创伤后PE的患者进行多中心回顾性病历审查。我们研究了患者的人口统计学资料、PE发生时的预防措施（药物预防[普通肝素或低分子量肝素]或序贯加压装置[SCD]）、所用诊断检查、从受伤日期到PE发生的时间以及生存结局。
共识别出146例患者，平均年龄45.1岁（标准差±21.1）；损伤严重度评分18.0（标准差±12.1）。通过螺旋计算机断层扫描确诊93例（N = 93），肺动脉造影确诊18例（N = 18），通气/灌注扫描确诊26例（N = 26），尸检确诊6例（N = 6），临床确诊6例（N = 6），不明确诊3例（N = 3）。总体死亡率为17.8%（N = 26）。在这些患者中，85%（N = 22）的患者认为肺栓塞是导致死亡的原因或促成因素。发生了两例晚期PE死亡（分别在第21天和第43天）。60例（37%）患者在PE发生时接受了药物预防，83例（50.9%）患者使用了SCD。从受伤到发生PE的平均时间为7.9天（标准差±8.1），最长为受伤后43天。11%的PE发生在21天之后，包括致命性PE。
应确定临床标准，以明确在不过早取出滤器而使患者面临PE风险的情况下取出临时性VCF的时间。
