Flinn W R, Sandager G P, Cerullo L J, Havey R J, Yao J S
Department of Surgery, Northwestern University Medical School, Chicago, Ill 60611.
Arch Surg. 1989 Aug;124(8):901-5. doi: 10.1001/archsurg.1989.01410080031004.
A total of 361 patients undergoing a variety of major neurosurgical procedures were entered into a prospective surveillance program using duplex ultrasound scanning for detection of perioperative deep venous thrombosis (DVT). All patients had duplex scans of the major veins of both legs preoperatively, on the third and seventh postoperative days, and at weekly intervals thereafter if hospitalized. All patients received elastic stocking and intermittent mechanical calf compression. Perioperative DVT was diagnosed by duplex scan in 17 cases (4.7%); 2 cases were present preoperatively and the remaining 15 cases developed after surgery. Venography detected only one false-positive scan in this series. One patient with DVT died, but the postmortem examination revealed no pulmonary embolism. The results of serial venous scans were normal in 344 cases. There were no in-hospital pulmonary embolisms in any patient with normal venous scan results. Two patients (0.6%) with normal serial scan results had fatal pulmonary embolism 1 and 3 weeks after discharge. Duplex venous scanning was useful for prospective DVT surveillance of a high-risk group. The overall incidence of DVT (4.7%) is below that expected in such patients, suggesting the effectiveness of the program of prophylaxis. Scan results were reliable for therapeutic decisions and did not jeopardize patient safety.
共有361例接受各种重大神经外科手术的患者进入一项前瞻性监测计划，该计划使用双功超声扫描来检测围手术期深静脉血栓形成（DVT）。所有患者在术前、术后第3天和第7天对双腿的主要静脉进行双功扫描，如果住院，则此后每周进行一次扫描。所有患者均接受弹力袜和间歇性小腿机械压迫。通过双功扫描诊断出围手术期DVT 17例（4.7%）；2例术前即存在，其余15例术后发生。在该系列中，静脉造影仅检测到1例假阳性扫描。1例DVT患者死亡，但尸检未发现肺栓塞。344例患者的系列静脉扫描结果正常。静脉扫描结果正常的患者中无院内肺栓塞发生。2例（0.6%）系列扫描结果正常的患者在出院后1周和3周发生致命性肺栓塞。双功静脉扫描有助于对高危人群进行前瞻性DVT监测。DVT的总体发生率（4.7%）低于此类患者的预期发生率，表明预防方案有效。扫描结果对于治疗决策可靠，且不危及患者安全。
