Gersin K, Grindlinger G A, Lee V, Dennis R C, Wedel S K, Cachecho R
Boston University School of Medicine, Department of Surgery, MA 02118-2393.
J Trauma. 1994 Aug;37(2):205-8. doi: 10.1097/00005373-199408000-00009.
Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients required mechanical ventilation. A sequential compression device (SCD) was used in 14 patients and 18 patients received no prophylaxis for thromboembolism. Bilateral lower extremity technetium venoscans and ventilation/perfusion (V/Q) lung scans were performed within 6 days of admission and every week for 1 month or until the patient developed DVT or PE or was discharged from the SICU. Deep venous thrombosis occurred in two patients (6%) at 16 and 28 days following trauma. Twenty-five patients had normal or low probability V/Q scans. Six had high probability V/Q scans confirmed by pulmonary arteriograms (PAGs) at 12.5 +/- 4 days. Clinical signs of PE were absent in all patients with a positive PAG. There were no differences in age, Injury Severity Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who developed DVT or PE and those who did not. A SCD was used in four of the eight patients with DVT or PE. All but one patient with DVT or PE underwent placement of a vena caval filter. Multiple trauma patients with severe head injury (GCS score < or = 8) are at high risk for thromboembolism. The available means of prevention and diagnosis of DVT or PE in multiple trauma patients with severe head injury are not entirely effective.
对32例重度颅脑损伤且格拉斯哥昏迷量表（GCS）评分为8分及以下的多发伤患者进行前瞻性研究，以评估深静脉血栓形成（DVT）和肺栓塞（PE）的发生率。所有患者均需机械通气。14例患者使用了序贯加压装置（SCD），18例患者未接受血栓栓塞预防措施。在入院后6天内以及之后1个月内每周进行双侧下肢锝静脉扫描和通气/灌注（V/Q）肺扫描，或直至患者发生DVT或PE或从外科重症监护病房（SICU）出院。2例患者（6%）在创伤后16天和28天发生深静脉血栓形成。25例患者的V/Q扫描结果正常或可能性较低。6例患者的V/Q扫描结果可能性较高，在12.5±4天时经肺动脉造影（PAG）证实。所有PAG阳性的患者均无PE的临床体征。发生DVT或PE的患者与未发生者在年龄、损伤严重度评分（ISS）、GCS评分、急性生理与慢性健康状况评分系统II（APACHE II）评分或创伤评分方面无差异。8例发生DVT或PE的患者中有4例使用了SCD。除1例DVT或PE患者外，其余均接受了腔静脉滤器置入术。重度颅脑损伤（GCS评分≤8）的多发伤患者发生血栓栓塞的风险较高。对于重度颅脑损伤的多发伤患者，现有的DVT或PE预防和诊断方法并不完全有效。
