减少血栓性栓塞症风险的新规范


  April 7, 2008(圣地牙哥) —根据医院医学会(Society of Hospital Medicine)2008年年会中发表的研究发现,因为有新规范确认高风险病患,大学医学中心的静脉血栓性栓塞症(VTE)比率明显下降。
  
  主要作者、加州大学圣地牙哥分校(UCSD)的内科临床教授Greg Maynard医师向Medscape内科医学表示,院内VTE(Hospital-acquired VTE,HAVTE)或许是可预防之院内死因的第1名,比HIV、机车事故、乳癌引起更多的死亡。
  
  Maynard医师表示,HAVTE是诸多问题的结果,重症住院病患通常有许多VTE相关风险,忙碌的医院员工可能会因为其它更紧急的任务而忽略它,医师的重点倾向于预防出血而非VTE预防,而事实上,血栓的风险远高于出血风险。
  
  共同作者、UCSD的内科临床副教授Ian Jenkins医师表示,此规范包括了计算机导引评估,依据年纪、手术、共病症、行动状态、有无预后治疗的禁忌症等,将病患分类为低、中、高风险。
  
  研究者检视规范,且从2005年中到2006年中搜集资料,在2007年上半年更新;从2007年下半年开始即时介入,病患适当预防的百分比从2005年的67%、增加到2006年的76%、直到2007年的92% (P < .001),在2007年底时达到98%。
  
  Jenkins医师表示,HAVTE 的比率,在2005至2006年的9,800名高风险病患中有130件,在2007年的10,600名病患中有 82件;院内肺栓塞发生率从2005至2006年的30件,到2007年的13件;深部静脉栓塞的比率从2005至2006年的平均148件,降到2007年的93件(两者的P < .05)。
  
  Jenkins医师表示,总的说来,每年约可有50名病患因此规范而免于发生VTE。
  
  未参与此研究的Terrebonne医学中心的Moira L. Ogden医师表示,同意HAVTE是住院病患的一种严重问题,这种规范有临床价值,因为我们在建立规范上需扮演领导角色,帮助减少医疗状况的发病率。
  
  2008年医院医学年会:摘要 52。发表于2008年4月3–5日。

New Protocol Reduces Risk for<

By Norra MacReady
Medscape Medical News

April 7, 2008 (San Diego) — Rates of venous thromboembolism (VTE) dropped significantly at a large university medical center thanks to a new protocol that identifies high-risk patients, according to findings presented here at Hospital Medicine 2008: the annual meeting of the Society of Hospital Medicine.

Hospital-acquired VTE (HAVTE) is "probably the number 1 cause of preventable hospital-associated death," lead investigator Greg Maynard, MD, clinical professor of medicine at the University of California, San Diego (UCSD), told Medscape Internal Medicine. "It causes more deaths than HIV, motor vehicle accidents, and breast cancer combined."

HAVTE results from a constellation of issues, said Dr. Maynard. Severely ill hospital patients usually have multiple risk factors for VTE, overworked hospital staff may forget about it as they address more urgent tasks, and clinicians tend to emphasize bleeding prevention over VTE prophylaxis, despite the fact that "the risk of a clot is logarithmically higher than the risk of bleeding."

The protocol consists of a computer-guided assessment that classifies patients as low, moderate, or high risk on the basis of factors such as age, procedure, comorbidities, ambulation status, and the presence of contraindications to prophylactic treatment, said coauthor Ian Jenkins, MD, associate clinical professor of medicine at UCSD.

The investigators tested the protocol and gathered consensus on it from mid-2005 to mid-2006, with further refinements made in the first half of 2007. Real-time intervention began in the second half of 2007. The percentage of patients on adequate prophylaxis rose from 67% in 2005 to 76% in 2006, and to 92% in 2007 (P < .001), reaching 98% in the final months of 2007.

The rate of HAVTE went from about 130 in about 9800 at-risk patients in 2005 to 2006 to 82 in about 10,600 patients in 2007, Dr. Jenkins said. The incidence of hospital-acquired pulmonary emboli went from about 30 in 2005 to 2006 to 13 in 2007. Rates of deep venous thrombi dropped from an average of 148 in 2005 to 2006 to 93 in 2007 (P < .05 for both).

All in all, "about 50 people per year can expect not to get VTE due to this protocol," Dr. Jenkins said.

HAVTE is a serious problem among hospitalized patients, agreed Moira L. Ogden, MD, a hospitalist at Terrebonne Medical Center in Houma, Louisiana, who was not involved in the study. A protocol like this "will be of clinical value because we must take a leadership role in the implementation of protocols that help decrease the morbidity associated with medical conditions."

Hospital Medicine 2008: Abstract 52. Presented April 3–5, 2008.

J Hosp Med. 2008;3(suppl 1):29.

    
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