Haljamäe H
Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg University, Sweden.
Acta Anaesthesiol Scand. 1996 Sep;40(8 Pt 2):1024-40. doi: 10.1111/j.1399-6576.1996.tb05621.x.
The surgery and trauma-induced modulation of the coagulation system includes a considerable risk of perioperative thromboembolic complications unless effective thromboprophylactic treatment is given. In the present survey the patient at risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is characterized and the documented efficacy of different currently used thromboprophylactic regimens is summarized. Systemic thromboprophylactic treatment may include a risk of an increased bleeding tendency which may lead to haemorrhagic complications. In patients with a coagulation abnormality or in patients receiving anticoagulants for perioperative thromboprophylaxis there is a fear among anaesthesiologists that the use of regional anaesthesia (spinal or epidural) may be associated with spinal haemorrhagic complications, i.e. with spinal haematoma formation leading to compression of the spinal cord and severe neurologic sequelae. Present aspects on the risk of spinal haematoma formation at the combined use of pharmacological thromboprophylactic regimens and spinal or epidural anaesthesia/ analgesia are therefore summarized. Pregnancy is associated with changes in the haemostatic system, which in the preeclamptic or eclamptic patient may be rather pronounced and constitute a clinical problem since regional anaesthetic techniques are often preferred for obstetric anaesthesia/analgesia. The specific problems to be considered prior to the choice of regional anaesthesia/analgesia for a parturient with a suspected coagulation disorder are therefore commented on in more detail. Finally, recommendations are given for safe spinal and epidural analgesic and anaesthetic routines in patients with potential haemostatic disturbances due to thromboprophylactic treatment with anticoagulants or bleeding disorders.
手术和创伤引起的凝血系统调节存在相当大的围手术期血栓栓塞并发症风险，除非给予有效的血栓预防治疗。在本次调查中，对有深静脉血栓形成（DVT）和肺栓塞（PE）风险的患者进行了特征描述，并总结了目前使用的不同血栓预防方案的已记录疗效。全身血栓预防治疗可能包括出血倾向增加的风险，这可能导致出血并发症。对于有凝血异常的患者或接受围手术期血栓预防抗凝治疗的患者，麻醉医生担心使用区域麻醉（脊髓或硬膜外）可能与脊髓出血并发症有关，即脊髓血肿形成导致脊髓受压和严重的神经后遗症。因此，总结了联合使用药物血栓预防方案与脊髓或硬膜外麻醉/镇痛时脊髓血肿形成风险的当前情况。妊娠与止血系统的变化有关，在先兆子痫或子痫患者中这种变化可能相当明显，并构成一个临床问题，因为区域麻醉技术通常是产科麻醉/镇痛的首选。因此，更详细地讨论了为疑似凝血障碍的产妇选择区域麻醉/镇痛之前需要考虑的具体问题。最后，针对因抗凝药物血栓预防治疗或出血性疾病而存在潜在止血障碍的患者，给出了安全的脊髓和硬膜外镇痛及麻醉常规的建议。
