在创伤性脑损伤的静脉血栓栓塞预防中存在差异,尽管国家有指导方针:来自最近AAST调查研究的见解
Keith Walter Burczak1, Jan-Michael Van Gent2, Devi Bavishi3
1The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Trauma surgery & acute care open
|October 29, 2025
概括
创伤外科医生在创伤性脑损伤 (TBI) 患者的静脉血栓栓塞 (VTE) 化学预防中表现出多样化的做法,尽管有指导方针. 实施更严格的协议对于及时,基于证据的护理至关重要.
科学领域:
- 创伤外科 手术 创伤外科
- 临界护理医学 临界护理医学
- 神经外科 神经外科
背景情况:
- 目前的指导方针建议对创伤性脑损伤 (TBI) 患者进行早期静脉血栓塞栓症 (VTE) 化学预防,通常在72小时内.
- 新出现的证据表明,在更早的24小时内启动VTE化疗预防可能是安全有效的.
- 在治疗TBI患者的创伤外科医生之间,VTE化疗预防的临床实践存在显著差异.
研究的目的:
- 评估创伤外科医生的当前做法和态度,以评估TBI患者的VTE化疗预防时间.
- 为了确定VTE化疗预防方案的变化和创伤外科医生之间的遵守.
- 将当前的做法与现有的文献和TBI中VTE预防的最佳实践指南进行比较.
主要方法:
- 一项全国性的在线调查分发给了美国创伤外科手术协会的1700名成员.
- 经常管理TBI患者的受访者被询问VTE化疗预防启动的机构指导方针和个人做法.
- 收集的数据包括机构协议,坚持率和TBI患者VTE化疗预防的首选时间.
主要成果:
- 在374名受访者中,大多数来自学术,一级创伤中心.
- 埃诺沙巴林是VTE化学预防中最常用的药物,以体重为基础的剂量和抗Xa测试是常见的.
- 虽然86%的人报告了机构协议,但只有59%的人大多符合规定,延迟往往是由于对TBI进展或服务间分歧的担忧. 43%的目标是在24小时内启动稳定的头部CT.
结论:
- 尽管有国家指导方针,但对TBI患者的VTE化疗预防时间存在显著差异.
- 像机构指导方针这样的被动策略单独不足以确保及时,基于证据的VTE预防.
- 有效的实施需要积极的战略,如协议强制订单集,临床决策支持和与其他服务的协作治理.
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