WEBVTT00:00:02.200-->00:00:06.180大家好今天我跟大家来聊一聊00:00:06.360-->00:00:08.880有来有关高龄卧床00:00:08.880-->00:00:11.960高危静脉血栓栓塞症防治00:00:11.960-->00:00:13.820中国专家共识00:00:15.400-->00:00:18.020那首先我们要理清一个概念00:00:18.280-->00:00:20.660什么是静脉血栓栓塞00:00:21.120-->00:00:24.420那么它包括深静脉血栓00:00:24.600-->00:00:25.940肺动脉栓塞00:00:26.720-->00:00:29.480其中我国80岁以上00:00:29.480-->00:00:32.260老年的静脉血栓栓塞发生率00:00:32.520-->00:00:35.940为每千人年6-8人00:00:36.480-->00:00:39.100而80岁以上住院患者00:00:39.640-->00:00:40.080BTE00:00:40.080-->00:00:42.600也就是静脉血栓栓塞症的发生率00:00:42.600-->00:00:45.700在欧洲达到11.8%00:00:46.000-->00:00:49.420我国国内为13.3%00:00:50.200-->00:00:51.620因此国内外00:00:51.840-->00:00:55.660高龄老年人VTE的防治形势00:00:55.760-->00:00:57.100非常严峻00:00:59.520-->00:01:02.140下为骨质啊00:01:02.480-->00:01:06.260比如瘀滞乳源高凝乳源内质损伤00:01:06.920-->00:01:09.900波长时间延长波长超过3天00:01:10.040-->00:01:10.840那么00:01:11.040-->00:01:14.420BG易发生风险显著紊乱超过7天00:01:14.520-->00:01:17.700生病呢损伤可发生率达15%00:01:18.280-->00:01:21.140超过两周得到32%00:01:21.520-->00:01:22.420因此00:01:22.640-->00:01:26.620长期卧床的患者尤其是高龄的患者00:01:26.680-->00:01:28.340必须高度供血00:01:29.360-->00:01:33.820针静脉静脉血栓栓塞的预防和检测00:01:34.880-->00:01:38.260高危的静脉血栓张斑会非常迅速00:01:38.400-->00:01:40.020多种锁定00:01:40.600-->00:01:42.580血状张斑恢复成损退00:01:43.440-->00:01:46.260包括但还是卧床00:01:46.840-->00:01:49.300个人或家族有关系00:01:49.800-->00:01:53.700并存在有慢性病并且有可能受过创伤00:01:54.080-->00:01:58.180遗传性的仍然增加影响和药物的使用00:01:58.760-->00:02:01.820活动比较少而80个以上的患者00:02:01.880-->00:02:04.460常常患有多个慢性疾病00:02:04.840-->00:02:08.060如支付脑疾病脑卒中肾上病毒00:02:08.720-->00:02:11.000森林个病人性的肝肾功能代谢00:02:11.000-->00:02:13.660导致老人家的安全和伪造作用00:02:14.560-->00:02:18.140约占60%以上的股民币00:02:18.200-->00:02:20.020尤其是私向股民币00:02:20.400-->00:02:24.380发展为利用商圈的风险显著00:02:25.240-->00:02:28.860发生率达50%而膝下00:02:29.160-->00:02:31.340肾中的损害不及时处理00:02:31.360-->00:02:35.380也可能向上或者导致肾动脉下沉00:02:36.480-->00:02:40.300因此大家可以80个以上高龄的说话00:02:40.760-->00:02:42.720以高度整体登记为选项00:02:42.720-->00:02:46.080修改综合评估并及时制定00:02:46.080-->00:02:47.740因为这也是因此00:02:50.600-->00:02:53.820噶末也包括以下两方面00:02:54.320-->00:02:58.380首先是分享选项的维护00:02:58.800-->00:03:00.580分为早期风险维护00:03:00.760-->00:03:03.500分析分析和呼吸分析方面00:03:04.280-->00:03:07.540导致病毒包括患者健康状况00:03:07.800-->00:03:10.580以及背景卧床时间等等00:03:11.000-->00:03:13.340那么就可以采取个性化00:03:13.360-->00:03:14.860对自己的防治策略00:03:15.560-->00:03:19.740那么尤其是要预防长期卧床导致患者00:03:20.080-->00:03:23.380还有骨折或者是术后康复的患者00:03:24.440-->00:03:26.100那么采用相应的00:03:26.480-->00:03:29.580papering平分和pagra平分00:03:30.920-->00:03:32.740那么其中可以看到00:03:33.120-->00:03:38.300文学因素1分2分3分5分等于都是为00:03:38.720-->00:03:42.580那么其中0分有的是极度低分数00:03:42.680-->00:03:43.6201到2分00:03:44.600-->00:03:46.460低危风险相当四00:03:46.880-->00:03:50.660是中危风险而高危风险为大于000:03:53.120-->00:03:55.300那么改良的开除量的分00:03:55.680-->00:03:59.940就是包括它还分为三四三个级别00:04:00.600-->00:04:02.140那么讲好三个字00:04:02.280-->00:04:04.900应该是低危分为高危00:04:05.480-->00:04:08.540那么高危出血患者我们出现GC以上00:04:08.680-->00:04:10.340VT还有VT00:04:11.640-->00:04:13.640Pagera的PTE成分呢00:04:13.640-->00:04:14.820有大家分00:04:15.200-->00:04:18.180为低分数低微分数和高微分数00:04:19.560-->00:04:21.940那么出血风险分数呢00:04:22.040-->00:04:24.300包括冷却的识别00:04:24.440-->00:04:25.700高输血分数00:04:26.560-->00:04:30.540同时呢制定个性化啊两个方案00:04:32.360-->00:04:34.980那么为手术是大数据00:04:35.280-->00:04:38.500那就包标记者要进行一个分享00:04:39.480-->00:04:41.740就包括一般为什么00:04:42.000-->00:04:46.380但g的大数据或者目前正的国位性00:04:47.400-->00:04:49.500你知道我已经治疗了00:04:50.160-->00:04:54.060严重了但是老板要求比老师多00:04:54.640-->00:04:57.620那么未控制神经病或血压00:04:57.960-->00:05:01.820哪怕都是未来引发出血的风险00:05:02.320-->00:05:05.700特定的物质包括在扶手术00:05:06.200-->00:05:09.380用阿司匹林和警察在内手里的人00:05:09.680-->00:05:11.620都有的本00:05:13.600-->00:05:17.260那么另外还有一个intwo就是平分00:05:17.520-->00:05:20.980那么我想它分为我写英语得分1分00:05:21.080-->00:05:22.9001.5就读到四点00:05:23.600-->00:05:25.920那么酒病就是危险因素长00:05:25.920-->00:05:28.780活动性为小小阳溃疡就得分00:05:29.120-->00:05:30.060非常的高00:05:30.440-->00:05:33.740那么高危因素就是大于非少00:05:35.600-->00:05:37.620另外因此专家建议00:05:38.040-->00:05:42.100日期或超过3天的所有高龄产品00:05:42.520-->00:05:45.140头枕宁静有区域00:05:47.000-->00:05:50.660那么针对所有的患者进行风险监测00:05:51.120-->00:05:53.940以及以指导咨询看DTV00:05:54.440-->00:05:55.980方案不对00:05:56.440-->00:05:59.820同时也因病情连续动态血酸00:05:59.880-->00:06:01.100DTV风险评估00:06:01.320-->00:06:05.180以指导DT防治方案相应调整00:06:06.360-->00:06:08.460那么鼻涕的诊断包括00:06:08.880-->00:06:10.460手诊断肚诊断00:06:11.040-->00:06:13.740练习4个诊断和颈项诊断00:06:14.840-->00:06:16.980首诊初诊中近视00:06:17.280-->00:06:20.680医师接诊患者没有进行特殊仪式检查00:06:20.680-->00:06:22.140但时间是停止的00:06:22.600-->00:06:25.600情况下形成定时定定形成表示00:06:25.600-->00:06:28.020以及一个检查要进行概率00:06:29.800-->00:06:31.280硫化氢是为了使空00:06:31.280-->00:06:34.900而对它的PPT诊断并是高的敏感00:06:35.240-->00:06:36.040所以00:06:36.800-->00:06:38.580那么这边就不太顺序00:06:39.160-->00:06:42.500那么他的这个b整段简化的00:06:42.840-->00:06:44.120就是为了平衡法00:06:44.120-->00:06:46.420这个应采用两分法00:06:47.040-->00:06:48.380那么实在是简化的00:06:48.480-->00:06:49.660第二次写的时候00:06:50.280-->00:06:53.460就可以注意互相常用这个方法00:06:55.040-->00:06:58.580那么敏感性可达到95%00:06:59.000-->00:07:01.260倍次和43%00:07:01.920-->00:07:04.540那么低概率的低清化结构00:07:04.720-->00:07:08.180主要是因素有显著的排除率00:07:08.760-->00:07:11.220排除率可达94%00:07:12.600-->00:07:13.700而高龄方面00:07:14.040-->00:07:16.480通常就是采用人类导见的00:07:16.480-->00:07:19.180把自己的浓度作为诊断依据00:07:20.000-->00:07:22.780推荐以年龄用10微毫克00:07:22.880-->00:07:24.86010微克每个称作为参考率00:07:25.680-->00:07:28.000而对于遮盖率较高的患者00:07:28.000-->00:07:31.940我们不能仅通过要进行FDP00:07:32.280-->00:07:34.820因结合超声检测措施00:07:34.920-->00:07:39.340我从不检测f进行一个动态的观察00:07:40.120-->00:07:41.680那么影像学检查呢00:07:41.680-->00:07:44.260是包括甲状功夫的超税00:07:44.680-->00:07:47.580但是PVT首诊诊断方案00:07:48.440-->00:07:50.920那么超分结果不明确的你就去00:07:50.920-->00:07:53.660走行另外的行去道行为道理00:07:53.920-->00:07:56.140或者是自动认定外道理00:07:56.200-->00:07:59.420或者是不实行自管道理进行的原则00:08:00.200-->00:08:01.780选择etc00:08:02.080-->00:08:04.680那么被动脉的CT成像00:08:04.680-->00:08:05.480CTC00:08:05.960-->00:08:09.220显示被动脉血内的血栓00:08:09.640-->00:08:12.540它具有高敏感性和良好的特异性00:08:13.160-->00:08:17.180是诊断意义求确的一种检查方法00:08:17.640-->00:08:20.260如果说GDP不能明确00:08:20.520-->00:08:22.860那么实物认的就明白solid00:08:23.040-->00:08:26.320而通知水文化就是扫描或应导管00:08:26.320-->00:08:28.060备受晚报应均可00:08:29.000-->00:08:30.940临床高度怀疑的患者00:08:31.000-->00:08:33.660要到7天之后自己发生特质00:08:34.200-->00:08:37.26080岁以上的高龄患者要考虑00:08:37.560-->00:08:40.980KTV和肺动脉报警时要首先提供00:08:41.160-->00:08:43.900肾功能的报告不做优胜00:08:45.320-->00:08:49.100那么这是一个规范的流程00:08:49.400-->00:08:53.380包括像疑似更新的循环和疑似00:08:53.400-->00:08:54.380这个网参观00:08:55.600-->00:08:58.040DC的预防和防治00:08:58.040-->00:09:01.300包括他的预抗霉素的硫酸反应00:09:01.360-->00:09:02.540HLA等等00:09:02.760-->00:09:05.700与微型肿瘤的合并是具有防治00:09:06.360-->00:09:08.640中心静脉导管相关损伤的防治00:09:08.640-->00:09:10.100骨科大手术的合并00:09:12.600-->00:09:15.980预防的包括病早性的运动锻炼00:09:16.360-->00:09:17.520运动预防和抗病00:09:17.520-->00:09:21.740药物与药物的一些方式联合00:09:23.720-->00:09:25.260常用的抗菌药物00:09:25.520-->00:09:27.200那么在抗菌药物来说00:09:27.200-->00:09:29.780首先要进行一个出血风险程度00:09:30.000-->00:09:31.860同时考虑共鸣状态00:09:32.000-->00:09:33.340复制一个最大的00:09:33.520-->00:09:35.700最合适的进行治疗方案00:09:36.480-->00:09:40.560PTE的高风险优化患者应优先考虑00:09:40.560-->00:09:42.440要有预防建议00:09:42.440-->00:09:45.520高龄患者预防性的患者治疗00:09:45.520-->00:09:48.900治疗标准治疗减半的治疗00:09:49.520-->00:09:51.000新型口服化农药00:09:51.000-->00:09:55.160有一高血灰色或不太适合长期注射00:09:55.160-->00:09:56.060农药00:09:57.200-->00:09:58.620的安全性高00:09:58.840-->00:10:01.940但同时也应该根据重功能状态00:10:02.000-->00:10:03.100这就合理00:10:04.880-->00:10:07.22020治疗那个支持00:10:07.320-->00:10:09.540那个润发营养就是推荐00:10:09.680-->00:10:11.220就是就是在顺序00:10:13.640-->00:10:15.560那么高龄的卧床00:10:15.560-->00:10:18.360但是没有高出血风险或者出血风险00:10:18.360-->00:10:19.700他是可控00:10:20.120-->00:10:23.140高危时期操作就应该导致的00:10:23.880-->00:10:24.740反应出来00:10:25.720-->00:10:29.420那么我们一般也都是听见推送的单数00:10:29.560-->00:10:33.940单独或者是联合口词的一种放人数00:10:34.480-->00:10:37.020进行放人的作为启动文字00:10:39.000-->00:10:42.300那么不同的就是种矿因子00:10:42.600-->00:10:44.940推荐并无优先级的区分00:10:44.960-->00:10:47.460但是它的用法用量并不同00:10:47.800-->00:10:50.940我们可以看到不同用途的绿茶沙滩00:10:51.440-->00:10:55.060iPad上的阿迪加图纸安卓沙滩等等00:10:55.600-->00:10:56.400那么00:10:56.520-->00:10:59.780他里面有一些都是需要胃肠外的矿物00:10:59.920-->00:11:02.900至少达到5,000以上才能进行00:11:05.360-->00:11:09.060那么u我们就是这个也就不再赘述00:11:09.600-->00:11:12.340那么这边我们再讲ETV00:11:12.440-->00:11:14.260是老血糖的变酸00:11:14.680-->00:11:16.900可以看到这些口服抗饮料的00:11:16.920-->00:11:17.860这两个气味00:11:18.040-->00:11:20.580它其实就是在弧度的上升00:11:21.480-->00:11:23.980那么评估的我们缺乏风险00:11:24.320-->00:11:26.620再一个决定抗原疗程00:11:27.200-->00:11:28.620那么它里面00:11:28.720-->00:11:32.100会提到一些常的呃微性的病00:11:32.560-->00:11:36.140因危的可能就是母鸡诱因持续存在00:11:36.800-->00:11:39.720那么2019应该是CT主疗00:11:39.720-->00:11:43.500那是CT检查那些患者得以需要00:11:44.320-->00:11:47.060健康抗体治疗就提到了00:11:47.400-->00:11:50.900因此发生也就是一过性的防护性00:11:51.720-->00:11:54.940而其他的患者均应该考虑00:11:55.400-->00:11:57.340无限次的联合00:11:58.120-->00:12:02.100那么如果说特别是像肾静脉像那个00:12:02.640-->00:12:06.180呃静脉口腔腔再复发有并有HS00:12:08.200-->00:12:12.560那么决定静脉血栓栓塞抗凝的持续00:12:12.560-->00:12:13.940时间的一个特点00:12:14.640-->00:12:18.320也包括啊不伴有肿瘤的血栓塞患者00:12:18.320-->00:12:21.240流传至少至少3个月00:12:21.240-->00:12:24.860可能治疗后那么他就是一个评估00:12:25.120-->00:12:29.300啊合并肿瘤扩张塞患者可以抗癌馈赠00:12:29.920-->00:12:32.480如果是肿瘤相关性的比较性状态00:12:32.480-->00:12:34.100会应该考虑延长00:12:34.360-->00:12:37.540是日久HC或者是无限00:12:39.040-->00:12:41.480那么决定这个兄弟们00:12:41.480-->00:12:44.980这个三三靠人和t之间的一个特点00:12:45.160-->00:12:46.820我觉得就比较正确00:12:48.040-->00:12:49.660抗菌药物治疗流程00:12:49.760-->00:12:51.980疗程呢单种来讲呢00:12:52.240-->00:12:55.500一般推荐我们进口型抗菌药三个月00:12:55.760-->00:12:58.300而肿瘤化一种呢一般是使用00:12:58.760-->00:13:01.500基本种单数黄色抗菌治疗00:13:02.400-->00:13:03.620那么专家建议00:13:04.120-->00:13:06.500啊常规抗凝治疗为3个月00:13:07.120-->00:13:09.180基于永久性的为左磷脂00:13:09.200-->00:13:13.540如恶性肿瘤脂肪性结聚和病友复燃塞00:13:13.920-->00:13:16.640在综合骨损伤和治疗风险后00:13:16.640-->00:13:19.500为这种缺口连杀抗凝五六个月00:13:19.560-->00:13:20.360不更吃00:13:21.400-->00:13:24.040那么龙川治疗还是到包括啥00:13:24.040-->00:13:26.700导管这些是哪样00:13:27.280-->00:13:29.820那么高龄的CT并不是00:13:32.680-->00:13:34.380那么舱内情况00:13:34.760-->00:13:39.260患者不推荐常规摄入MC预防死亡00:13:39.880-->00:13:41.660那么有症状的应该患者00:13:42.200-->00:13:44.920得以进行综合评估与风险之后00:13:44.920-->00:13:46.180决定是否00:13:46.720-->00:13:48.260摄入MC00:13:49.600-->00:13:50.460压力治疗00:13:51.080-->00:13:53.380可以作为降除血栓形成的00:13:53.760-->00:13:56.040后脸综合征的重要措施00:13:56.040-->00:13:58.020但禁用于新发的00:13:58.760-->00:14:00.580就是静脉血栓栓塞00:14:01.040-->00:14:02.420通常在急性期00:14:02.800-->00:14:07.300至少两周后综合评估是否使用压力00:14:08.680-->00:14:10.620恶性肿瘤主要并用00:14:10.880-->00:14:11.860放开了治疗00:14:12.400-->00:14:15.080那么恶性肿瘤就是治疗水疗伤害00:14:15.080-->00:14:16.420同时治疗密切00:14:17.040-->00:14:20.140推荐基本3次作为恶性肿瘤00:14:20.880-->00:14:22.980这种病应该是在伤害的00:14:23.160-->00:14:25.700不是维持治疗的恶性肿瘤00:14:27.080-->00:14:29.760另外还有像煞是孤立性的00:14:29.760-->00:14:31.820远端的神经的伤害00:14:32.440-->00:14:35.140他这是无症状是无扩展患00:14:35.240-->00:14:39.180高龄患者首先建议患有治疗两周00:14:39.480-->00:14:42.620之后综合组织治理患者疗方案00:14:43.120-->00:14:45.980如果说有血栓扩展高风险患00:14:46.360-->00:14:48.140者可推荐进行患者治疗00:14:48.840-->00:14:52.280症状性ABPD是有创意与疾病进展00:14:52.280-->00:14:55.120自由力伤害建议禁止3个月00:14:55.120-->00:14:59.500选择超声进行连续动产00:15:00.840-->00:15:03.520那么高龄患者尤对中心静脉导管00:15:03.520-->00:15:05.560也试图具有的稳定性区域00:15:05.560-->00:15:09.860但是推荐常规的预防性患者治疗00:15:10.680-->00:15:12.420那么一般00:15:12.800-->00:15:16.000就是就是他对于保留早管期间的话00:15:16.000-->00:15:17.480就可能3个月完00:15:17.480-->00:15:19.160就是如果有明确的就可以早管00:15:19.160-->00:15:20.100相关的事情00:15:20.400-->00:15:23.740那必须拔出险的话就重新考虑3-7天00:15:23.960-->00:15:25.300拔除后还是继续考虑00:15:26.040-->00:15:27.520骨科大小就合并00:15:27.520-->00:15:28.580所以注意的话00:15:28.640-->00:15:32.140那么也是恢复参与的时间规定00:15:33.080-->00:15:35.940这是2020年的管理aC00:15:36.160-->00:15:38.100s管理组的快修复00:15:38.560-->00:15:40.840那么就是核心里面要讲的一句话00:15:40.840-->00:15:44.380叫动态模式的进行一个监控00:15:45.000-->00:15:48.140那么专家建议在CT的防治期间00:15:48.440-->00:15:51.160应该动态的遵守反光的取消00:15:51.160-->00:15:54.140定时的进行资产操作和方案00:15:54.920-->00:15:56.220最后就是整形00:15:56.440-->00:15:58.880那么高龄患者也可以注意的00:15:58.880-->00:16:00.340发现高危人群00:16:00.360-->00:16:04.560我们应该进行最好的前置动态监测00:16:04.560-->00:16:05.480相关的指标00:16:05.480-->00:16:08.940根据患者具体情况进行合适的方案00:16:09.240-->00:16:11.580好我今天的分享就到这拜拜