Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts, USA.
Clin Appl Thromb Hemost. 2009 Oct;15(5):512-6. doi: 10.1177/1076029608330471. Epub 2009 Jun 1.
We compared 315 patients with deep vein thrombosis who underwent major orthopedic surgery with 618 who underwent general surgery in a prospective registry of consecutive ultrasound-confirmed deep vein thrombosis patients. Orthopedic patients had fewer indwelling central venous catheters (14.0% vs. 46.4%, P < .0001) as well as lower rates of congestive heart failure (7.0% vs. 13.4%, P = .002), cancer (5.1% vs. 28.6%, P < .0001), and diabetes (7.0% vs. 12.6%, P = .004). Extremity discomfort (43.5% vs. 30.3%, P < .0001) and erythema (10.1% vs. 4.8%, P = .001) were more common in orthopedic patients, but dyspnea was less common (11.4% vs. 18.0%, P = .005). There was an increased use of graduated compression stockings (19.4% vs. 15.0%, P = .04), low-molecular-weight heparin (18.7% vs. 12.1%, P = .003), and warfarin (31.7% vs. 11.0%, P < .0001) for deep vein thrombosis prophylaxis in the orthopedic surgery group. Orthopedic surgical patients had a higher frequency of calf deep vein thrombosis than patients who underwent general surgery (38.4% vs. 2.1%, P < .0001). In both groups, 28% did not receive prophylaxis. In conclusion, despite having fewer comorbid conditions, orthopedic patients with deep vein thrombosis remain particularly vulnerable to calf deep vein thrombosis. Rates of venous thromboembolism prophylaxis were inadequate.
我们比较了在一项连续超声确诊深静脉血栓患者前瞻性登记研究中接受骨科大手术的 315 例深静脉血栓患者与接受普外科手术的 618 例患者。骨科患者中心静脉留置导管的比例较低（14.0% vs. 46.4%，P<.0001），充血性心力衰竭（7.0% vs. 13.4%，P=.002）、癌症（5.1% vs. 28.6%，P<.0001）和糖尿病（7.0% vs. 12.6%，P=.004）的发生率也较低。肢体不适（43.5% vs. 30.3%，P<.0001）和红斑（10.1% vs. 4.8%，P=.001）在骨科患者中更为常见，但呼吸困难较少见（11.4% vs. 18.0%，P=.005）。骨科手术组更常使用梯度压力弹力袜（19.4% vs. 15.0%，P=.04）、低分子肝素（18.7% vs. 12.1%，P=.003）和华法林（31.7% vs. 11.0%，P<.0001）进行深静脉血栓预防。骨科手术患者小腿深静脉血栓的发生率高于普外科患者（38.4% vs. 2.1%，P<.0001）。在这两组中，有 28%的患者未接受预防治疗。总之，尽管骨科深静脉血栓患者的合并症较少，但仍特别容易发生小腿深静脉血栓。静脉血栓栓塞预防的比率不足。
