JBJS:研究揭示脊柱融合术后静脉血栓栓塞事件的高危因素

2014-08-04 佚名 丁香园

从 1998 年到 2008 年间,美国脊柱融合术的数量增加了 1 倍多(1998 年 174223 例,2008 年为 413171 例)。考虑到脊柱融合术的经济费用和大幅度增加,批判性地评估手术结果和调查其潜在的并发症显得很关键。静脉血栓栓塞事件包括肺栓塞和深静脉血栓,其是潜在的死亡预防因素。在美国,每年大约 1/3 的静脉血栓相关死亡病例(15 万 -20 万例)是术

从 1998 年到 2008 年间,美国脊柱融合术的数量增加了 1 倍多(1998 年 174223 例,2008 年为 413171 例)。考虑到脊柱融合术的经济费用和大幅度增加,批判性地评估手术结果和调查其潜在的并发症显得很关键。静脉血栓栓塞事件包括肺栓塞和深静脉血栓,其是潜在的死亡预防因素。在美国,每年大约 1/3 的静脉血栓相关死亡病例(15 万 -20 万例)是术后发生的。

静脉血栓预防是当今研究的热点。机械预防措施,包括弹力袜压缩和断续的气动压缩装置,均能降低静脉血栓发生率。药物预防的选择,如低分子量肝素,也能有效地预防静脉血栓。在静脉血栓预防上,全国各地和内部机构存在很大的差异。目前,仍缺乏高质量的证据直接指导临床医师对静脉血栓事件进行预防的选择。

鉴于此,美国纽约大学的 Vadim Goz 教授等进行了一项回顾性研究,通过收集美国国家住院患者样本数据库资料,来调查脊柱融合术患者发生静脉血栓栓塞事件的患者因素和手术相关因素,其相关研究结果已在近期的 JBJS 杂志上发表。研究结果显示,2001 年至 2010 年间国家住院患者样本中确定行脊柱融合术患者总计 710154 例。美国国家住院患者数据库记录的静脉血栓栓塞事件是 3777 例,包括 1739 例(0.24%)肺栓塞和 2038 例(0.29%)深静脉血栓。

静脉血栓栓塞患者的平均年龄是偏大的(静脉血栓栓塞者 57.63 岁,非静脉血栓栓塞者 52.88 岁),好发于男性(男性 0.58%,女性 0.42%)和黑种人(黑种人:0.78%,白种人:0.47%)。从手术适应症来看,静脉血栓栓塞事件发生率最高的是创伤患者,其次是脊柱畸形患者。从手术入路来看,静脉血栓栓塞事件发生率最高的是后路胸椎患者,其次是前路胸椎患者。术后静脉血栓栓塞发生率与住院日增加(18.0 天 VS 3.94 天)和总住院费用增加($207,253 VS $66,823)相关。

另外,一系列的并存病和手术相关因素被认为是静脉血栓事件的独立危险因素。本研究的不足在于,1、大样本数据的纳入导致收集数据时缺乏间隔,很多临床细节没有记录。因此,该法不能评估血栓栓塞预防方法的有效性。2、纳入患者涉及全国各地,存在潜在的异质性。3、数据库只承认症状性的静脉栓塞事件,这可能低估真实的术后静脉血栓栓塞事件发生率。4、该研究为回顾性研究,其特点决定了该研究为诊疗性研究 III 级。

因此,基于本研究识别的独立危险因素,作者提出了脊柱融合术后静脉血栓栓塞的风险指数。结合当前的指南,这一风险指数可以用来指导临床决策中有关接受脊柱融合术的患者进行静脉血栓栓塞的预防。

原始出处:

Goz V1, McCarthy I2, Weinreb JH1, Dallas K1, Bendo JA1, Lafage V1, Errico TJ1.Venous Thromboembolic Events After Spinal Fusion: Which Patients Are at High Risk?J Bone Joint Surg Am. 2014 Jun 4;96(11):936-942. [Epub ahead of print]

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    2014-12-05 fusion
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    2014-10-12 xue8602
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    2014-08-06 licz0427
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    2014-08-06 qingrejiedu

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