脊髓损伤(SCI).ppt

Deep Venous Thrombosis Swelling Fever of unknown origin Increased spasticity and AD Clinically apparent DVT occurs in approximately 15% to 50%. DVT can lead to pulmonary embolism (5-10%) and death. DVT Treatment Anticoagulation with Lovenox, Heparin, and or coumadin If clinically contraindicated place venacaval filter Continue activity and compression garments DVT/PE Prevention Guidelines All patients will be on Lovenox or Heparin to prevent blood clot: Non-complicated spinal cord injury (no co-morbidity) will have 8 weeks of treatment Complicated spinal cord injury (having at least one co-morbidity) will have 12 weeks of treatment Standard of care to prevent DVT: Anticoagulation Therapy at therapeutic doses (Lovenox 30mg SQ BID or Heparin 5000 units SQ BID/TID), SCD’s while in bed, and Tedhose and/or Ace Wraps when out of bed. Pearls DVT occurs in 40-90% of patients depending on the degree of prophylaxis. Risk factors decline in 8-12 weeks. Proximal progression of DVT and pulmonary embolism occur in 20-50%. Historicaly clinical factors believed to be associated with DVT include motor complete injuries, paraplegia, and male gender. In a recent study by Powell et al, there was no statistical difference in incidence of DVT between motor complete versus motor incomplete injuries, tetraplegic versus paraplegic, or traumatic versus nontraumatic causes. Thus, all SCI patients are at risk of developing a DVT. Powell M, Kirshblum S, OConnor KC. Arch P Med Rehabil. 1999 Sep;80(9):1044-6 Pulmonary Embolism Venacaval Filter Coronary Heart Disease Coronary Heart Disease is thought to increase after SCI due to: physical inactivity obesity hyperlipidemia insulin resistance diabetes CHD accounts for approximately 20% of deaths in the SCI population. Modifiable risk factors for CHD prevention include high blood pressure, smoking, obesity, physical inactivity, and cholesterol and/or lipid control. This risk may be increasingly important as the life expect