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--> 00:06.927\n静脉血栓栓塞症VTE包括深静脉血栓DVT和肺动脉栓塞PE。\n\n00:07.077 --> 00:11.302\n80岁以上老年VTE发生率为每1000人每年6.8人，\n\n00:11.302 --> 00:15.239\n80岁以上住院患者VTE发生率达到11.8%，\n\n00:15.239 --> 00:20.177\n国内80岁以上住院患者VTE发生率为百分13.3%。\n\n00:21.443 --> 00:22.368\n嗯，\n\n00:22.368 --> 00:27.792\nVTE的危险因素包括血流淤滞、血液高凝血管内皮损伤。\n\n00:27.792 --> 00:29.868\n主要是因为卧床时间延长，\n\n00:29.868 --> 00:31.218\n卧床超过3天，\n\n00:31.218 --> 00:33.643\nVTE的发生率风风险显著增加。\n\n00:33.842 --> 00:35.667\n卧床超过7天以上，\n\n00:35.667 --> 00:37.193\nDVT发生率达到15%，\n\n00:37.342 --> 00:39.518\n卧床超过14天，\n\n00:39.518 --> 00:41.243\nVTE的发生率高达32%。\n\n00:41.443 --> 00:42.842\n长期卧床患者，\n\n00:42.842 --> 00:46.092\n尤其是高龄患者必须高度重视VTE的预防和监测。\n\n00:47.824 --> 00:51.824\n高危VTE患者通常是指合并多种VTE风险因素的个体，\n\n00:52.023 --> 00:53.249\n包括长期卧床，\n\n00:53.249 --> 00:55.523\n个人或家族血栓史并存，\n\n00:55.523 --> 00:56.223\n慢性疾病，\n\n00:56.223 --> 00:57.523\n近期手术或创伤，\n\n00:57.673 --> 01:00.173\n遗传性血栓倾向影响凝血，\n\n01:00.173 --> 01:01.824\n药物使用活动减少等。\n\n01:02.124 --> 01:05.348\n80岁以上高龄患者常伴有多种慢性疾病，\n\n01:05.348 --> 01:06.299\n如心血管疾病，\n\n01:06.299 --> 01:06.774\n脑卒中，\n\n01:06.774 --> 01:07.624\n糖尿病等，\n\n01:07.723 --> 01:12.323\n生理病理性肝肾功能减退导致的抗凝治疗安全和有效性问题，\n\n01:12.424 --> 01:14.124\n约占60%的DVT，\n\n01:14.174 --> 01:17.098\n尤其膝上DVT发展为PE风险显著升高，\n\n01:17.098 --> 01:18.024\n发生率在5%。\n\n01:18.081 --> 01:21.505\n50以上膝下D、VT如不及时合理处理，\n\n01:21.505 --> 01:22.505\n也可能向上扩展，\n\n01:22.505 --> 01:23.081\n导致P。\n\n01:24.102 --> 01:24.928\n专家建议，\n\n01:24.928 --> 01:28.828\n80岁以上高龄卧床患者应高度重视VTE风险综合评估，\n\n01:28.828 --> 01:32.002\n并及时制定针对性的监测和防治方案。\n\n01:35.638 --> 01:37.337\n早期评估和风险分级，\n\n01:37.737 --> 01:38.112\n嗯，\n\n01:38.112 --> 01:41.087\n包括健康状况、疾病背景和卧床时间。\n\n01:44.658 --> 01:44.783\n嗯，\n\n01:44.783 --> 01:47.908\n主要有改良的PE量表，\n\n01:48.308 --> 01:49.808\n简化为三个级别。\n\n01:49.958 --> 01:51.408\n0到四分为低危，\n\n01:51.408 --> 01:52.708\n建议机械性的预防。\n\n01:52.908 --> 01:54.884\n5到八分是中危，\n\n01:54.884 --> 01:55.583\n有大出血，\n\n01:55.583 --> 01:56.083\n有低危，\n\n01:56.083 --> 01:57.208\n建议使用。\n\n01:59.128 --> 02:09.203\nWMWLMWH7.10天的机械性预防大于等于9分是高危大出血低危大出血低危。\n\n02:09.203 --> 02:13.229\n建议使用LMWH 30添加机械性预防，\n\n02:13.229 --> 02:18.179\n高危出血风险患者推荐机械预防至出血停止家用药物预防。\n\n02:22.692 --> 02:26.667\n另一张量表低危风险是小于4分，\n\n02:26.667 --> 02:26.867\nD,\n\n02:26.867 --> 02:28.716\nVT发生率小于10%，\n\n02:28.716 --> 02:31.192\n尽建议尽早活动基础预防，\n\n02:31.492 --> 02:33.192\n大于等于四分是高危风险，\n\n02:33.192 --> 02:33.367\nD,\n\n02:33.367 --> 02:35.591\nVT发生风险为40%.80%，\n\n02:35.591 --> 02:37.242\n死亡率达到1%.5%。\n\n02:37.442 --> 02:41.192\n药物预防LMWH加物理预防。\n\n02:42.404 --> 02:43.429\n出血风险评估，\n\n02:43.429 --> 02:45.404\n准确识别高出血风险患者，\n\n02:45.505 --> 02:47.404\n制定个性化抗凝方案，\n\n02:47.554 --> 02:49.955\n为术期大出血危险因素评估，\n\n02:50.054 --> 02:53.029\n围术期患者improve出血评分，\n\n02:53.029 --> 02:54.255\n内科住院患者。\n\n03:00.710 --> 03:03.759\nImprove出血评分高危风险是大于等于7分。\n\n03:06.113 --> 03:06.912\n专家建议，\n\n03:07.113 --> 03:09.888\n预期卧床超过3天的所有高龄患者，\n\n03:09.888 --> 03:12.563\n首诊既应进行VTE的风险评估，\n\n03:12.763 --> 03:15.438\n应对所有患者进行出血风险评估，\n\n03:15.438 --> 03:18.013\n以指导个性化的VTE防治方案制定，\n\n03:18.162 --> 03:21.162\n应进行连续动态血栓及出血风险评估，\n\n03:21.162 --> 03:24.013\n以指导VTE的预防方案相应调整。\n\n03:25.307 --> 03:27.483\nBTE的诊断包括首诊初步诊断，\n\n03:27.483 --> 03:29.983\n实验室检查和影像学检查相结合。\n\n03:30.533 --> 03:34.233\n首诊初步诊断临床检验前概率诊断评估，\n\n03:34.233 --> 03:39.283\n首诊医生接诊患者时未进行特殊仪器检测及实验室检测情况下，\n\n03:39.432 --> 03:46.033\n结合病史、共病情况、临床表现及体格检查而进行的概率诊断评估。\n\n03:46.082 --> 03:48.832\n主要用的是简化维尔S评分，\n\n03:48.832 --> 03:52.233\n对提升DVT诊断有更高的敏感性和特异性。\n\n03:54.738 --> 03:56.738\n实验室检测主要是靠D2，\n\n03:56.738 --> 03:59.889\n具体检测是VTE的初筛常用方法，\n\n03:59.988 --> 04:01.789\n敏感性约为95%，\n\n04:01.938 --> 04:03.438\n特异性为43%。\n\n04:03.438 --> 04:06.813\n低概率的VTE患者中D2聚体阴性具有排除意义，\n\n04:06.813 --> 04:08.389\n排除率可达97%。\n\n04:08.639 --> 04:12.389\n高龄患者采用年龄矫正的D2具体浓度作为诊断依据，\n\n04:12.488 --> 04:17.338\n推荐以年龄每岁乘以10μg/L作为预参考阈值，\n\n04:17.639 --> 04:20.088\n对于预防概率较高的患者，\n\n04:20.088 --> 04:23.164\n不仅不能仅通过D2聚体排除VTE，\n\n04:23.164 --> 04:24.989\n应结合超声检测等措施。\n\n04:25.076 --> 04:25.976\n或重复检测，\n\n04:25.976 --> 04:27.502\n排除期排除，\n\n04:27.502 --> 04:28.476\n进行动态观察。\n\n04:28.976 --> 04:32.127\n影像学的检查包括彩色的多普勒，\n\n04:32.177 --> 04:36.402\n彩色多普勒超声检查是DVT的首选诊断方法。\n\n04:36.402 --> 04:43.252\n超声结果不明确的近端DVT可行静脉CT造影或者磁共振静脉造影，\n\n04:43.252 --> 04:46.052\n或者数字减影血管造影术诊断。\n\n04:46.052 --> 04:49.226\nDPT肺动脉CT成像显示肺动脉内血栓，\n\n04:49.377 --> 04:51.951\n评估PE严重程度和范围。\n\n04:51.951 --> 04:55.027\n具有高敏感性和良好特异性是诊断。\n\n04:55.045 --> 04:58.096\nP的首选影像学检查方法，\n\n04:58.295 --> 05:07.170\n如果CTPA不明确的PE磁共振肺动脉造影比比Q扫描或经导管肺血管造影，\n\n05:07.170 --> 05:08.246\n可辅助诊断。\n\n05:08.446 --> 05:12.545\n临床高度怀疑的患者需5.7天后进行超声复查。\n\n05:12.795 --> 05:16.496\n八十岁以上高龄患者考虑CTV和肺动脉造影时，\n\n05:16.696 --> 05:19.346\n需首先评估肾功肾功能状况，\n\n05:19.346 --> 05:20.596\n不做优先推荐。\n\n05:22.792 --> 05:23.643\nVTE的防治。\n\n05:25.980 --> 05:28.579\nBT预防应该尽早进行运动锻炼，\n\n05:28.579 --> 05:29.554\n机械性的预防，\n\n05:29.554 --> 05:32.579\n抗凝药物预防以及药物与机械方式联合预防。\n\n05:32.980 --> 05:34.279\n抗凝药物治疗，\n\n05:34.329 --> 05:39.855\n常用的抗凝药物及剂量选择抗凝治疗前应首先进行出血风险评估，\n\n05:39.855 --> 05:44.154\n同时综合考虑共病状态比比如进展期的肿瘤，\n\n05:44.154 --> 05:44.929\n肾功能状况，\n\n05:44.929 --> 05:46.079\n肥胖易栓症，\n\n05:46.079 --> 05:51.279\n联合用药VTE部位等确定最适合急性期治疗方案。\n\n05:51.329 --> 05:54.079\n对于出血风险可控的VTE高龄患者，\n\n05:54.130 --> 05:55.980\n建议尽早早期。\n\n05:56.292 --> 06:02.042\n启动抗凝治疗BTE的高风险卧床患者应优先考虑药物预防。\n\n06:02.192 --> 06:09.243\n建议高龄患者预防性抗凝治疗剂量采用标准治疗剂量减半剂量。\n\n06:10.424 --> 06:17.373\n新型口服抗凝药物可用于高出血风险或不适合长期注射抗凝药物患者，\n\n06:17.424 --> 06:18.373\n安全性高，\n\n06:18.373 --> 06:22.023\n但应根据肾功能等状况确定合理用药方案。\n\n06:26.305 --> 06:31.705\n高龄卧床无高出血风险或出血风险相对可控的高位BTE患者，\n\n06:31.805 --> 06:33.506\n早期启动抗凝治疗，\n\n06:33.705 --> 06:36.156\n华法林可以作为维持药物选择，\n\n06:36.156 --> 06:37.506\n但不推荐首选，\n\n06:37.705 --> 06:39.455\n且不采用复合剂量，\n\n06:39.455 --> 06:42.330\n应维持INR在1.6.2.5，\n\n06:42.330 --> 06:43.855\nTTI保持在70%以上。\n\n06:44.256 --> 06:48.531\n推荐LMWH单独或联合DOAC作为启动治疗。\n\n06:48.531 --> 06:54.205\n肾功能滤过率小于百分之小于30ml/min的推荐答。\n\n06:54.953 --> 06:55.352\n甘肃。\n\n06:56.653 --> 07:02.403\n黄达甘奎钠在无肾功能受损时可考虑选择且无需调节剂量。\n\n07:02.753 --> 07:03.153\n嗯，\n\n07:03.204 --> 07:06.704\n在肾小球滤过率小于三十的患者禁用。\n\n07:06.753 --> 07:10.553\n优先推荐DOAC作为高龄急性VTE维持治疗，\n\n07:10.553 --> 07:11.653\n口服抗凝药物。\n\n07:11.753 --> 07:19.253\n各种DOAC均应首先评估肌酐清除率和并相应减剂量和个个体化调整。\n\n07:19.253 --> 07:26.854\n不建议DOAC与PGP和CYP三A四双重抑制药双重诱导药等药物。\n\n07:26.912 --> 07:29.338\n联合使用不同DAC推荐，\n\n07:29.338 --> 07:30.812\n并无优先级的区分，\n\n07:30.812 --> 07:32.312\n用法用量各不相同。\n\n07:33.513 --> 07:38.912\n艾多沙班和达比加群酯治疗前均要求胃肠外抗凝至少5天。\n\n07:46.218 --> 07:48.644\n决定VTE抗凝持续时间的策略，\n\n07:48.644 --> 07:51.769\n不伴肿瘤肺栓塞患者的延长期管理，\n\n07:51.769 --> 07:55.069\n至少完成3个月的抗凝治疗，\n\n07:55.368 --> 08:00.069\n而合并肿瘤栓塞患者抗凝是肿瘤相关的PE，\n\n08:00.069 --> 08:02.006\n在完成6个月抗凝治疗后，\n\n08:02.006 --> 08:06.669\n应考虑延长抗凝直至肿瘤治愈或无限期抗凝。\n\n08:07.118 --> 08:11.368\n肿瘤相关病疫前6个月应考虑体重调整的皮下注射WM。\n\n08:12.442 --> 08:14.717\nLMWH优于VK。\n\n08:17.480 --> 08:19.205\n抗凝药物治疗疗程，\n\n08:19.205 --> 08:23.631\n非肿瘤患者推荐首先使用DAC进行3个月的抗凝治疗，\n\n08:23.830 --> 08:27.430\n肿瘤患者推荐使用LMWH长期抗凝治疗，\n\n08:27.680 --> 08:32.330\n非一过性诱因引起的VTE患者推荐使用DOAC长期抗凝治疗，\n\n08:32.431 --> 08:35.830\n不能接受DOAC的患者推荐华法林治疗。\n\n08:37.247 --> 08:41.348\n病因不明的近端D、VT或P患者在停止抗凝治疗后，\n\n08:41.348 --> 08:43.297\n推荐使用阿司匹林预防复发。\n\n08:43.598 --> 08:49.247\n延长期抗凝治疗患者推荐减少剂量的阿哌沙班或利伐沙班进行治疗，\n\n08:49.247 --> 08:51.297\n并根据病情进行调整，\n\n08:51.297 --> 08:53.247\n治疗时间可超过6个月。\n\n08:53.547 --> 08:56.747\n专家建议抗凝常规抗凝疗程为3个月，\n\n08:56.898 --> 09:02.297\n基于永久性危险因素如恶性肿瘤或特发性VTE或合并PE，\n\n09:02.447 --> 09:04.755\n在综合评估血栓和出血风险后，\n\n09:04.755 --> 09:07.348\n决定是否延长抗凝至6个月或更长。\n\n09:08.020 --> 09:11.870\n溶栓治疗导管接触性溶栓，\n\n09:12.070 --> 09:15.421\n通过将溶栓导管置入静脉血栓内，\n\n09:15.421 --> 09:17.820\n使溶栓药物直接作用于血栓。\n\n09:18.370 --> 09:22.645\n系统性溶栓是通过外周静脉全身应用溶栓药物。\n\n09:22.645 --> 09:26.471\n专家建议高龄的VTE不建议系统性溶栓治疗。\n\n09:26.620 --> 09:31.471\n中央型或混合性DVT或PE患者在出血风险较低，\n\n09:31.770 --> 09:33.883\n并无其他绝对禁忌症时，\n\n09:33.883 --> 09:37.471\n应在多科综合评估后慎重考虑是否进行CD。\n\n09:37.520 --> 09:37.770\n体。\n\n09:38.960 --> 09:42.210\n腔内治疗不推荐常规置入IVC预防PE。\n\n09:42.411 --> 09:47.760\n有症状的PE或下腔静脉及髂骨静脉急性血栓形成患者，\n\n09:47.911 --> 09:50.861\n存在抗凝治疗禁忌症或治疗失败时，\n\n09:50.861 --> 09:53.010\n应综合评估获益与风险，\n\n09:53.161 --> 09:54.710\n决定是否置入IVC。\n\n09:55.434 --> 10:00.633\n压力治疗VTE压力治疗可作为消除血栓形成后综合症重要措施，\n\n10:00.934 --> 10:02.833\n但禁用于新发VTE。\n\n10:03.033 --> 10:07.934\n常通常在急性期至少两周后综合评估是否使用压力治疗。\n\n10:08.736 --> 10:10.786\n恶性肿瘤合并VTE的防治，\n\n10:10.835 --> 10:12.760\n恶性肿瘤与VTE关系密切，\n\n10:12.760 --> 10:13.948\n无出血禁忌时，\n\n10:13.948 --> 10:18.986\n应对所有卧床、住院、卧床高龄恶性肿瘤患者进行VTE的预防。\n\n10:19.335 --> 10:25.435\n推荐LMWH作为恶性肿瘤患者VTE初始和维持治疗的首选药物。\n\n10:27.211 --> 10:32.611\n下肢孤立性远端DBT的治疗无症状且无扩展的IDDBT，\n\n10:32.611 --> 10:35.711\n高龄卧床患者建议首先抗凝治疗，\n\n10:35.711 --> 10:39.111\n两周之后综合评估制定下一步治疗方案。\n\n10:39.211 --> 10:42.861\n血栓扩展高风险患者则推荐继续抗凝治疗。\n\n10:43.161 --> 10:47.411\n症状性IDDVT的抗凝与急性近端DVT相同，\n\n10:47.411 --> 10:49.411\n建议进行3个月的抗凝治疗，\n\n10:49.461 --> 10:53.762\n建议采用超声检查进行连续性动态评估。\n\n10:54.836 --> 10:56.986\n中心静脉导管相关血栓的防治，\n\n10:57.137 --> 11:00.986\n高龄患者流失中心静脉导管是VTE的危险因素之一，\n\n11:01.086 --> 11:03.637\n不推荐常规预防性的抗凝治疗。\n\n11:03.786 --> 11:06.687\n明确诊断为导管相关VTE患者，\n\n11:06.836 --> 11:11.836\n不推荐常规拔除导管导流期间需持续抗凝3个月，\n\n11:11.937 --> 11:14.887\n必须拔除前需充分抗凝3.7天，\n\n11:14.937 --> 11:16.786\n拔除后继续抗凝3个月。\n\n11:17.377 --> 11:22.427\n骨科大手术合并VTE防治高龄老年骨科术后如无禁忌，\n\n11:22.526 --> 11:25.651\n应尽早采用药物或物理方法预防。\n\n11:25.651 --> 11:31.377\nVTE大手术患者预预防期限应延长术后35天。\n\n11:33.565 --> 11:35.015\n动态持续监测，\n\n11:35.265 --> 11:37.315\n定期监测患者下肢情况，\n\n11:37.315 --> 11:39.265\n动态进行相关辅助检查，\n\n11:39.515 --> 11:44.164\n定期检测凝血相关指标及动态进行出血风险评估。\n\n11:45.823 --> 11:48.924\n对置入I VC患者进行定期影像学随访，\n\n11:48.924 --> 11:50.848\n以评估滤器位置和功能，\n\n11:50.848 --> 11:52.823\n最大限度的减少VT的发生。\n\n11:54.299 --> 11:56.349\n动态持续监测。\n\n11:56.500 --> 11:57.674\n专家建议，\n\n11:57.674 --> 12:02.599\nVTE防治期间应动态监测患者临床表现及实验室指标监测，\n\n12:02.650 --> 12:05.000\n定期进行血管超声等辅助检查，\n\n12:05.000 --> 12:06.650\n动态调整防治方案。\n\n12:08.132 --> 12:14.182\n总结高龄卧床高危患者的静脉血栓栓塞症早期评估风险，\n\n12:14.182 --> 12:18.482\n以分级以及出血风险评估至关重要。\n\n12:18.982 --> 12:24.333\n临床检测前概率诊断评估是BTE诊断的关键第一步。\n\n12:24.682 --> 12:29.882\n疑诊D、VT及PE高龄患者应通过简化威尔S评分，\n\n12:30.033 --> 12:32.033\n结合年龄校正的D二，\n\n12:32.033 --> 12:34.882\n具体进入临床诊断评估流程。\n\n12:35.937 --> 12:44.138\nBTE规范诊断流程是结合临床评估、实验室检测和影像学检查进行综合判断。\n\n12:45.041 --> 12:46.241\n高龄住院患者，\n\n12:46.291 --> 12:48.241\n如内科重症慢性。\n\n12:49.231 --> 12:58.031\n慢病患者、骨科、多种疾病患者、重症监护病房、肿瘤科及术后患者群体是VTE的高发人群。\n\n12:58.331 --> 13:00.632\n预防方案应该选择个体化。\n\n13:19.064 --> 13:23.388\n在不伴肿瘤肺栓塞患者的延长期管理中，\n\n13:23.388 --> 13:24.263\nBTE如果复发，\n\n13:24.263 --> 13:26.814\n至少发生一次肺栓塞或者DVT，\n\n13:26.963 --> 13:30.864\n但不是继发于重大一过性或可逆危险因素的患者，\n\n13:31.114 --> 13:33.614\n推荐进行无限期延长的抗凝。\n\n13:33.864 --> 13:40.213\n抗磷脂抗体综合症患者推荐使用VKA进行无限期的延长抗凝。\n\n13:40.513 --> 13:46.263\n伴有轻微的一过性或可逆性危险因素或持续性危险因素的患者，\n\n13:46.414 --> 13:48.763\n或没有可识别危险因素。\n\n13:49.320 --> 13:51.020\n应考虑延长抗凝治疗。\n\n13:51.320 --> 13:54.309\n在完成起始抗凝治疗6个月后，\n\n13:54.309 --> 14:00.921\n应考虑阿哌沙班2.5mg比亚迪或利伐沙班10MGQ、D用于延长抗凝治疗。\n\n14:02.833 --> 14:05.184\n合并肿瘤肺栓塞患者抗凝推荐，\n\n14:05.333 --> 14:08.083\n肿瘤相关P在完成6个月抗凝治疗后，\n\n14:08.083 --> 14:12.033\n应考虑延长抗凝直至肿瘤治愈或无限期抗凝。\n\n14:12.083 --> 14:17.083\n肿瘤相关P前6个月应考虑体重调整的皮下注射WM。\n\n14:18.531 --> 14:20.705\nLMWH优于VKA，\n\n14:20.806 --> 14:23.156\n除外消化道肿瘤患者，\n\n14:23.156 --> 14:29.556\n可考虑艾多沙班利伐沙班作为LMWH皮下注射的替代药物。\n\n14:30.689 --> 14:34.289\n这个是BT的抗凝持续时间的一个策略。\n\n14:50.343 --> 14:53.692\n以上内容是D、VT的一个。\n\n14:55.513 --> 14:59.763\n危险因素及评估以及它的用药。\n\n15:00.890 --> 15:01.289\n方案。\n\n15:03.268 --> 15:03.617\n谢谢。\n\n","v0247cg10004d60raeqljht605ullqo0",911,663,"2026-01-24 21:14:34"," 高龄卧床高危静脉血栓栓塞防治指南 - 专业预防与护理建议  "," 高龄卧床,静脉血栓栓塞,预防措施,血栓护理,卧床患者护理,深静脉血栓,肺栓塞防治  "," 本文提供高龄卧床患者静脉血栓栓塞(VTE)的全面防治方案，涵盖风险评估、预防措施、护理要点及紧急处理方法，帮助降低深静脉血栓和肺栓塞风险，保障卧床患者安全。","2026-06-11 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