选择性脊柱手术后的化学预防和静脉血栓塞栓症:系统性审查和元分析
Roman Rahmani1, Samuel Eaddy1, Samuel D Stegelmann2
1Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United States.
North American Spine Society journal
|January 11, 2024
概括
在选择性脊椎手术患者中,外科化学预防并没有显著改变静脉血栓塞栓症 (VTE) 或脊柱外周血瘤 (SEH) 的发生率. 需要进一步的研究来确定最佳的VTE预防方案为这一群体.
科学领域:
- 神经外科 神经外科
- 血管外科 血管外科
- 麻醉学 麻醉学
背景情况:
- 静脉血栓塞栓症 (VTE),包括深静脉血栓症 (DVT) 和肺栓塞 (PE),是手术后的一种严重并发症.
- 脊柱手术带有术后出血的风险增加,例如脊柱外周血瘤 (SEH),使抗凝药的使用复杂化.
- 目前的指导方针缺乏关于选择性脊柱手术患者的外科手术期间静脉动脉瘤预防的共识.
研究的目的:
- 调查化疗对选择性脊柱手术中静脉动脉瘤和SEH发病率的影响.
- 系统地审查有关该患者群体VTE预防的现有文献.
主要方法:
- 在PubMed,Embase和Cochrane数据库中对2000年后的研究进行了系统的文献搜索.
- 包括的研究比较了选择性脊柱手术中的VTE化疗,不包括18岁以下的创伤,癌症或脊髓损伤的患者.
- 计算了VTE和SEH的聚合发病率,并进行了元分析以评估化疗预防效应.
主要成果:
- 分析了19项涉及220932名患者的研究.
- 总体汇总的VTE发病率为3.2% (DVT为3.3%,PE为0.4%).
- 在接受和不接受化疗预防的患者之间,在VTE (OR 0.97,p=.95) 或SEH (OR 1.57,p=.06) 发病率上没有发现统计学上显著的差异.
结论:
- 在选择性脊柱外科手术中,外科化学预防可能不会显著影响VTE或SEH率.
- 需要进行进一步的随机对照试验,以建立基于证据的VTE预防方案,用于多种多样的选择性脊柱手术亚群.
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