Eriksson S, Backman L, Ljungström K G
Department of Surgery, Karolinska Institutet, Danderyd Hospital, Sweden.
Obes Surg. 1997 Aug;7(4):332-5; discussion 336. doi: 10.1381/096089297765555575.
Suggested risk factors for postoperative thrombosis such as high fatty acid levels, hypercholesterolemia and diabetes are common in obese patients.
In a retrospective study, the case records of 328 patients operated for obesity by gastric procedure from September 1977 until December 1993 were analyzed: 253 women and 75 men with a mean age of 38 years and a mean body mass index (BMI) of 44 kg/m2. The operation time, use of epidural anesthesia, and the occurrence of risk factors; fatty acid levels, hypercholesterolemia and diabetes were recorded. Symptomatic thromboses were verified by phlebography or phlethysmography and pulmonary embolism with ventilation/perfusion scintigraphy or autopsy.
The mean operating time was 128 minutes, 77% had epidural anesthesia and the mean hospital stay was 12.3 days. The long hospital stay was due to the fact that most patients took part in different scientific studies perioperatively. The incidence of thromboembolism was 2.4%. Four patients had pulmonary embolism, in one of them this was fatal. Three patients had deep leg vein thrombosis and one patient had arm thrombosis secondary to a central venous catheter. None of these patients had high fatty acids, diabetes or high cholesterol. Of the patients, 298 were given dextran-70 (Macrodex, Pharmacia) as prophylaxis, seven were given heparin and 23 were given no prophylaxis. In the patient group without diagnosed thrombosis, 31% had high fatty acid levels, 2% had high cholesterol levels and 9% had diabetes.
Obese patients seem to have a moderate risk of developing postoperative thrombosis when an effective prophylaxis is used. High free fatty acids, hypercholesterolemia and diabetes are not obvious extra risk factors in obese patients. Thromboprophylaxis should be given to all operated obesity patients regardless of age. The surgeons must be aware and investigate promptly any symptoms suggestive of thromboembolism.
术后血栓形成的潜在危险因素，如高脂肪酸水平、高胆固醇血症和糖尿病，在肥胖患者中很常见。
在一项回顾性研究中，分析了1977年9月至1993年12月期间因肥胖接受胃部手术的328例患者的病例记录：253名女性和75名男性，平均年龄38岁，平均体重指数（BMI）为44kg/m²。记录手术时间、硬膜外麻醉的使用情况以及危险因素的发生情况；脂肪酸水平、高胆固醇血症和糖尿病。通过静脉造影或静脉体积描记法以及通气/灌注闪烁扫描或尸检来确诊有症状的血栓形成和肺栓塞。
平均手术时间为128分钟，77%的患者接受硬膜外麻醉，平均住院时间为12.3天。住院时间长是因为大多数患者在围手术期参与了不同的科学研究。血栓栓塞的发生率为2.4%。4例患者发生肺栓塞，其中1例死亡。3例患者发生下肢深静脉血栓形成，1例患者因中心静脉导管继发手臂血栓形成。这些患者均无高脂肪酸、糖尿病或高胆固醇。298例患者接受右旋糖酐-70（Macrodex，法玛西亚公司）预防，7例患者接受肝素预防，23例患者未接受预防。在未诊断出血栓形成的患者组中，31%有高脂肪酸水平，2%有高胆固醇水平，9%有糖尿病。
当采用有效的预防措施时，肥胖患者术后发生血栓形成的风险似乎中等。高游离脂肪酸、高胆固醇血症和糖尿病在肥胖患者中并非明显的额外危险因素。所有接受手术的肥胖患者，无论年龄大小，均应给予血栓预防。外科医生必须意识到并及时调查任何提示血栓栓塞的症状。
