...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of vascular surgery >Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma.
【24h】

Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma.

机译：在多发性创伤患者中，在血管内超声引导下，放置在ICU床旁的预防性临时下腔静脉滤器的作用。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

OBJECTIVE: Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava (IVC) filters (IVCFs) offer protection against pulmonary embolism during the early immediate injury and perioperative period, when risk is highest, while averting potential long-term sequelae of permanent IVCFs. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound (IVUS) guidance in patients with multiple trauma. INTERVENTIONS: Ninety-four patients with multiple trauma seen between July 1, 2002, and November 1, 2003, underwent placement of OptEase (Cordis Endovascular) retrievable IVCFs under real-time IVUS guidance. Mean (+/-SD) Injury Severity Score was 25.1 +/- 2.2). Abdominal x-ray films were obtained in all patients to verify filter location. Before IVCF retrieval all patients underwent femoral vein color-flow ultrasound scanning to rule out deep vein thrombosis (DVT), and pre-procedure and post-procedure vena cavography to identify possible IVCF thrombus entrapment and post-retrieval inferior vena cava injury. RESULTS: Nineteen patients died of their injuries; no deaths were related to IVCF placement. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein DVT occurred. As verified on abdominal x-ray films, 96.8% (91 of 94) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 2 groin hematomas (2.1%) and 3 IVCFs misplaced in the right iliac vein (3.2%), early in our experience; the filters were uneventfully retrieved and replaced in the inferior vena cava within 24 hours. Thirty-one patients underwent uneventful retrieval of IVCFs after DVT or pulmonary embolism anticoagulation prophylaxis was initiated. Forty-four filters were not removed, 41 because severity of injury prevented DVT or pulmonary embolism prophylaxis and 3 because of thrombus trapped within the filter. CONCLUSIONS: Prophylactic, temporary IVCF placement at the intensive care unit bedside under IVUS guidance in patients with multiple trauma is simple and safe, and serves as an effective "bridge" to anticoagulation therapy until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in patients with multiple trauma is warranted. CLINICAL RELEVANCE: Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava filters (IVCFs) offer protection against pulmonary embolism during the perioperative and immediate injury period, when risk is highest. Ninety-four patients with multiple trauma underwent prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein deep venous thrombosis occurred. Ninety-one of 94 IVCFs (96.8%) were placed without complication. Thirty-one patients underwent uneventful retrieval of IVCFs after anticoagulation prophylaxis was initiated. Forty-four filters were not removed, because of severity of injury (n = 41) or because of trapped thrombus within the filter (n = 3). Prophylactic, temporary IVCFs placed under intravascular ultrasound guidance at the bedside in patients with multiple trauma is simple, safe, and an effective bridge to anticoagulation therapy.
机译：目的：多发性创伤患者经常会受伤，无法使用抗凝治疗或预防性连续加压装置。临时性下腔静脉滤器（IVCF）在早期损伤和围手术期风险最高的情况下，可预防肺栓塞，同时避免永久性IVCF的长期后遗症。这项研究的目的是评估在多发性创伤患者中，在实时血管内超声（IVUS）指导下，在重症监护病房床边进行预防性临时IVCF放置的疗效。干预措施：在2002年7月1日至2003年11月1日之间发现的94例多发创伤患者在实时IVUS指导下接受了OptEase（Cordis血管内）可取回IVCF的置入。平均（+/- SD）损伤严重度评分为25.1 +/- 2.2）。所有患者均获得腹部X光片以确认滤光片的位置。在进行IVCF检索之前，所有患者均接受股静脉彩色流超声扫描以排除深静脉血栓形成（DVT），并在手术前和手术后腔静脉造影术中确定可能的IVCF血栓夹带和and愈后下腔静脉损伤。结果：19名患者因伤致死。没有死亡与IVCF安置有关。滤器取出后的随访过程中发生1例肺栓塞，发生1例股静脉DVT插入部位。如腹部X光片所证实的那样，在L2-3水平放置了96.8％（94个中的91个）IVCF，无并发症。与滤器相关的并发症包括2例腹股沟血肿（2.1％）和3例IVCF在mis静脉右部错位（3.2％）;过滤器被顺利取出，并在24小时内更换到下腔静脉中。开始DVT或肺栓塞抗凝预防后，对31例患者进行了IVCF的无障碍恢复。没有移除四十四个过滤器，其中41个由于损伤的严重性阻止了DVT或肺栓塞的预防，还有三个原因是因为血栓被困在了过滤器中。结论在多发性创伤患者中，在IVUS指导下在重症监护病房床头进行预防性的临时IVCF放置是简单而安全的，并且可以作为抗凝治疗的有效“桥梁”，直到可以开始预防静脉血栓栓塞。有必要进一步研究这种床旁技术以及临时IVCF在多发性创伤患者中的作用。临床相关性：多发伤患者通常会受伤，无法使用抗凝治疗或预防性连续加压装置。临时下腔静脉滤器（IVCF）可在围手术期和眼外伤期间（最高风险）提供保护，防止肺栓塞。 94名多发创伤患者在实时血管内超声检查下在重症监护病房床旁进行了临时性IVCF预防性放置。滤器取出后的随访过程中发生1例肺栓塞，并发生1处股静脉深静脉血栓插入部位。 94个IVCF中有91个（96.8％）放置无并发症。开始抗凝预防后，对31例患者进行了IVCF的无障碍恢复。由于伤势严重（n = 41）或由于血栓被困在过滤器内（n = 3），因此未移除四十四个过滤器。对于患有多种创伤的患者，在床旁血管内超声引导下进行的预防性临时IVCF简便，安全，是抗凝治疗的有效桥梁。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号