Rodriguez J L, Lopez J M, Proctor M C, Conley J L, Gerndt S J, Marx M V, Taheri P A, Greenfield L J
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109, USA.
J Trauma. 1996 May;40(5):797-802; discussion 802-4. doi: 10.1097/00005373-199605000-00020.
Pulmonary embolism (PE) is a major problem in patients with multiple injuries. We present our experience with early placement of prophylactic vena caval filters (VCFs).
Prospective study group with historical control.
From March 1993 to December 1993, VCFs were placed in 40 consecutive patients with three or more risk factors for PE and had demographic, physiologic, venous thromboembolic prophylaxis, and outcome data collected prospectively (VCF group). They were compared to 80 injured patients admitted between November 1991 and February 1993 who survived > 48 hours and who were matched with the VCF group for mechanism of injury and risk factors for PE (NO VCF group).
VCF placement affected a significant reduction in the incidence of PE (2.5% vs. 17%) and a clinical reduction in PE-related mortality. Embolic trapping was suggested by a 10% incidence of documented vena caval thrombi and although two patients developed significant venous stasis disease, no other VCF-related morbidity was noted.
In spite of long-term morbidity, early prophylactic VCF placement is safe and should be considered in the prophylaxis of PE in the high-risk injured patients. This intervention may be effective in eliminating PE as a major cause of posttrauma morbidity and mortality.
肺栓塞（PE）是多发伤患者的一个主要问题。我们介绍早期放置预防性腔静脉滤器（VCF）的经验。
有历史对照的前瞻性研究组。
1993年3月至1993年12月，连续40例有三个或更多PE危险因素的患者接受了VCF置入，并前瞻性收集了人口统计学、生理学、静脉血栓栓塞预防及预后数据（VCF组）。将他们与1991年11月至1993年2月间入院且存活超过48小时、在损伤机制和PE危险因素方面与VCF组匹配的80例受伤患者进行比较（无VCF组）。
VCF置入使PE发生率显著降低（2.5%对17%），与PE相关的死亡率临床降低。腔静脉血栓形成记录发生率为10%提示有栓子捕获，尽管有2例患者发生了严重的静脉淤滞疾病，但未发现其他与VCF相关的并发症。
尽管存在长期并发症，但早期预防性VCF置入是安全的，对于高危受伤患者预防PE时应予以考虑。这种干预可能有效地消除PE作为创伤后发病和死亡的主要原因。
