Bendinelli Cino, Balogh Zsolt
Department of Traumatology, Division of Surgery, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia.
Curr Opin Crit Care. 2008 Dec;14(6):673-8. doi: 10.1097/MCC.0b013e3283196538.
In trauma patients, pulmonary embolism occurs in up to 4% of cases and carries a mortality of 20-50%. The incidence of deep vein thrombosis (DVT) varies from 5 to 63% depending on patients' risk factors, modality of prophylaxis, and methods of detection. For these reasons, trauma patients require adequate DVT prophylaxis.
Spinal fracture or cord injury patients are at particular risk. Increasing injury severity, head injury, older age, lower limb injuries, and obesity are other risk factors. The current standard of care for DVT prophylaxis is enoxaparin (a low molecular weight heparin) as long as anticoagulation is not contraindicated. Unfractionated heparin alone does not provide sufficient protection against DVT. Selective factor Xa inhibitors such as fondaparinux are showing promising results. Other strategies for pulmonary embolism prevention include: graduated compression stockings, sequential compression devices, continuous passive motion, and prophylactic inferior vena cava filter. There is lack of consensus regarding the optimal DVT prophylaxis in trauma patients and few level I recommendations exist.
Best practice in thromboprophylaxis for trauma patients will remain on the basis of recommendations until definitive risk-benefit ratios are determined to justify the use of various mechanical and pharmacological measures, in combination or alone.
在创伤患者中，肺栓塞的发生率高达4%，死亡率为20% - 50%。深静脉血栓形成（DVT）的发生率因患者的危险因素、预防方式及检测方法而异，为5%至63%。因此，创伤患者需要充分的DVT预防措施。
脊柱骨折或脊髓损伤患者风险尤其高。损伤严重程度增加、头部损伤、年龄较大、下肢损伤及肥胖是其他危险因素。只要没有抗凝禁忌证，目前DVT预防的标准治疗方法是使用依诺肝素（一种低分子量肝素）。单独使用普通肝素不能提供足够的DVT防护。选择性Xa因子抑制剂如磺达肝癸钠显示出有前景的结果。其他预防肺栓塞的策略包括：分级加压弹力袜、序贯加压装置、持续被动运动及预防性下腔静脉滤器。关于创伤患者最佳DVT预防措施尚无共识，一级推荐也很少。
在确定各种机械和药物措施联合或单独使用的明确风险效益比以证明其合理性之前，创伤患者血栓预防的最佳实践仍将基于推荐意见。
