Yorozu Tomoko
Masui. 2014 Mar;63(3):278-86.
Perioperative pulmonary thromboembolism (PTE) occurred in 2.93 per 10,000 cases and mortality of PTE was 14% in Japan according to the surveillance of Japanese Society of Anesthesiologists from 2009 to 2011. Anesthesiologists have to evaluate perioperative venous thromboembolism (VTE) risk carefully and take adequate measures to prevent PTE. The first step is the assessment of the preoperative probability of VTE and the next step is the assessment of the risk for VTE during and after operation. If a patient has moderate probability of VTE preoperatively, diagnostic procedures are recommended. If the d-dimer is positive, whole-leg ultrasound is recommended. If DVT is positive in proximal vein, further investigation or anticoagulant therapy are considered. Primary preventions of VTE during and after surgeries are as follows. In patients with low or moderate risks for VTE, intermittent pneumatic compression is recommended. In patients with high risks for VTE, pharmacologic prophylaxes are recommended. In recent years newly developed anticoagulants can be available other than low-dose unfractionated heparin. However, the incidence of VTE in Japanese populations is different from western countries. Moreover our own evidence has not fully been accumulated yet. Therefore further investigations for prevention of perioperative VTE in Japan are expected for our own new guidelines.
根据日本麻醉医师协会2009年至2011年的监测，围手术期肺血栓栓塞症（PTE）的发生率为每10000例中有2.93例，PTE的死亡率为14%。麻醉医师必须仔细评估围手术期静脉血栓栓塞症（VTE）的风险，并采取适当措施预防PTE。第一步是评估术前VTE的可能性，第二步是评估手术期间和术后VTE的风险。如果患者术前VTE可能性为中度，建议进行诊断性检查。如果D-二聚体呈阳性，建议进行全腿超声检查。如果近端静脉DVT呈阳性，则考虑进一步检查或抗凝治疗。手术期间和术后VTE的一级预防如下。对于VTE低风险或中度风险的患者，建议使用间歇性气动压迫。对于VTE高风险的患者，建议进行药物预防。近年来，除了低剂量普通肝素外，还可以使用新开发的抗凝剂。然而，日本人群中VTE的发生率与西方国家不同。此外，我们自己的证据尚未充分积累。因此，期待在日本开展进一步的围手术期VTE预防研究，以制定我们自己的新指南。
