骨科术后静脉血栓的预防与护理.pptVIP

肢体肿胀、酸痛、浅静脉怒张、皮温高单侧肢体增粗、肿胀突然出现的呼吸困难或活动后气短胸痛胸闷咳血低氧血症和低碳酸血症--提示并发DVT--提示并发PTEVTE的临床表现小腿中部以下水肿病变在腘静脉膝以下水肿疼痛为股浅静脉双侧下肢水肿为下腔静脉大腿中部以下水肿为股静脉单肢臀部以下水肿为髂总静脉下肢肿胀、疼痛和浅静脉曲张是下肢DVT的三大症状下肢DVT的临床表现下肢DVT的临床表现远端DVT近端DVT多隐匿，可无自觉症状或只有患肢轻度疼痛和沉重感，逐渐出现膝关节以下肿胀，腓肠肌深压痛或Homan症可出现高热，下肢明显疼痛，非对称性肿胀，皮肤轻度紫绀，皮下静脉怒张和淤点01DVT是源，PTE是果，没有DVT防重于治，防患于未然02预防DVT就是预防PTE很少发生PTEVTE的预防与护理骨科血栓预防专家建议联合预防药物预防基本预防基本预防措施物理（机械）预防措施药物预防措施联合预防机械预防基本预防措施手术操作轻柔精细，避免静脉内膜损伤规范使用止血带术后抬高患肢，防止深静脉回流障碍常规进行静脉血栓知识宣教，鼓励患者勤翻身、早期功能锻炼、下床活动、做深呼吸及咳嗽动作术中和术后适度补液，多饮水，避免脱水建议患者改善生活方式，如戒烟、戒酒、控制体重、控制血糖、控制血脂等LogoLogoLogoThereisaverystrongassociationbetweenpulmonaryembolism(PE)anddeepveinthrombosis(DVT):-90%ofpulmonaryemboliaretheresultsofDVT-Arecentstudyshowedthat82%ofpatientswithacutePEhaddetectableDVTatthetimePEwasdiagnosed.-SilentPEoccursinmorethan50%ofpatientswithsymptomaticproximalDVT.Asthevenousclotintheleggrowsitextendsalongthevein.DVTcandevelopintoachronicconditioninwhichdamagetothevalvesintheveinsresultsinswellingoftheleg,painandvenoushypertension(knownaspost-thromboticsyndrome-PTS)Partsoftheclotcanalsodetach,travellinginthebloodtoblockvesselsinthelungs,subsequentlycausingpulmonaryembolism(PE).Iflessthan50%ofthepulmonarycirculationisblocked,symptomsaregenerallylimitedtoshortnessofbreathorareabsentaltogether.Verylargeemboli,however,cancausemassiveblockageofthepulmonarycirculationandrapidlyleadtodeath.1.PesaventoR,LusianiL,VisonaA,etal.Prevalenzadiemboliapolmonareclinicamentesilentenellatrombosivenosaprofondadegliartiinferiori.MinervaCardioangiologica1997;45:369-375.2.GirardP,MussetD,ParentF,MaitreS,PhlippoteauC,SimmonneauG.Highprevalenceofdetectabledeepvenousthrombosisinpatientswithacutepulmonaryembolism.Chest1999;116:903-908.VTEisoftensilent