Frezza Eldo E, Wachtel Mitchell S
Department of Surgery, Division of General Surgery, Texas Tech University Health Sciences Center, MOP Building, Suite 380, 3502 9th Street, Lubbock, TX 79415, USA.
Obesity (Silver Spring). 2006 Nov;14(11):1961-5. doi: 10.1038/oby.2006.229.
Pulmonary embolism is a leading cause of death for bariatric patients. Numerous regimens have been proposed, but a comprehensive, simple approach is lacking. This study provides a simple, easily implemented prophylaxis regimen.
One hundred fifty bariatric surgery patients were evaluated. Patients considered at high risk for venous thromboembolism had heart failure, a BMI of >/=50 kg/m(2), or a history of venous thromboembolism or pelvic surgery. Preoperatively and postoperatively, all patients received subcutaneous enoxaparin or unfractionated heparin. High-risk patients received either preoperatively inserted inferior vena cava filters or continuous heparin infusions intraoperatively. All high-risk patients were anticoagulated with warfarin (Coumadin; Bristol Myers-Squibb, Princeton, NJ) for at least 3 months postoperatively. Initially, some patients experienced significant hemorrhage; to prevent this, sutures were oversewn into staple lines.
No patient experienced venous thromboembolism; a binomial test showed that the regimen reduced the risk of this complication to less than 2% (p < 0.05). Hemorrhage sufficient to require transfusion occurred in 4 of the first 20 patients; of the remaining 130 patients, into whose staple lines sutures were oversewn, none required transfusion (p < 0.05).
Patients should be divided into those who are at high risk and those who are at low risk for venous thromboembolism. All patients should receive pre- and postoperative anticoagulation. High-risk patients should also receive either an inferior vena cava filter or intraoperative heparin infusions, as well as at least 3 months of Coumadin therapy. Oversewing of staple lines may reduce the risk of hemorrhage.
肺栓塞是肥胖症患者死亡的主要原因。虽然已经提出了多种治疗方案,但仍缺乏一种全面、简单的方法。本研究提供了一种简单、易于实施的预防方案。
对150例肥胖症手术患者进行了评估。被认为静脉血栓栓塞高风险的患者有心力衰竭、体重指数(BMI)≥50kg/m²、静脉血栓栓塞病史或盆腔手术史。术前和术后,所有患者均接受皮下注射依诺肝素或普通肝素。高风险患者术前接受下腔静脉滤器植入或术中持续肝素输注。所有高风险患者术后至少3个月接受华法林(香豆素;百时美施贵宝公司,新泽西州普林斯顿)抗凝治疗。最初,一些患者出现了严重出血;为预防这种情况,在吻合钉行处进行了缝合加固。
没有患者发生静脉血栓栓塞;二项式检验表明,该方案将这种并发症的风险降低至2%以下(p<0.05)。前20例患者中有4例发生了需要输血的出血;在其余130例进行了吻合钉行缝合加固的患者中,无人需要输血(p<0.05)。
应将患者分为静脉血栓栓塞高风险和低风险两类。所有患者术前和术后均应接受抗凝治疗。高风险患者还应接受下腔静脉滤器植入或术中肝素输注,以及至少3个月的香豆素治疗。吻合钉行缝合加固可能会降低出血风险。