在非心脏动脉手术中进行手术性肝素化:荷兰当前的实践
Liliane C Roosendaal1,2,3, Max Hoebink1,2,3, Arno M Wiersema1,2,3
1Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands.
概括
在荷兰,非心脏动脉手术 (NCAP) 期间使用肝素在荷兰有很大差异. 需要进一步的研究来优化肝素剂量方案,并提高血管外科手术中的患者安全.
科学领域:
- 血管外科 血管外科
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
背景情况:
- 氨酸是预防非心脏动脉手术 (NCAP) 期间血栓栓塞并发症的关键抗凝剂.
- 目前关于围绕程序性肝素管理的指导方针缺乏证据,导致不统一的做法.
- 了解NCAP当前的抗血栓策略对于开发最佳方案至关重要.
研究的目的:
- 调查目前在荷兰NCAP期间围绕程序性肝素管理的实践.
- 为了确定荷兰医院之间肝素化方案的局部差异和变化.
- 为协调肝素剂量和提高患者安全奠定基础.
主要方法:
- 在所有执行NCAP的荷兰医院向血管外科医生分发了一份全面的在线调查.
- 数据收集发生在2020年9月至2021年10月期间.
- 该调查实现了90%的高响应率 (59家医院中有53家).
主要成果:
- 在NCAP期间,所有外科医生都在动脉紧之前注射了肝素.
- 大多数医院 (74%) 使用单次肝素剂量协议,但40%的外科医生缺乏统一性.
- 固定的肝素注射剂 (主要为5000 IU) 是常见的 (73%-93%),而基于体重的剂量 (70-100 IU/kg) 用在7%-27%的患者中.
- 只有28%的人使用激活凝血时间 (ACT) 监测肝素的效果,目标值可变.
结论:
- 在荷兰,在NCAP期间的手术性肝素化仍然存在显著的医院内和医院间的变化.
- 这种变异性强调了需要高质量的证据来指导抗凝策略的需要.
- 未来的研究和国际调查计划协调协议,并加强血管外科患者的护理.
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