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--> 00:08.489\n今天我要讲的题目是高龄卧床高危静脉血栓栓塞症防治中国专家共识。\n\n00:10.296 --> 00:10.496\n首先，\n\n00:10.496 --> 00:12.847\n从概念及流行病学来说，\n\n00:13.046 --> 00:18.547\n心脉血栓栓塞症包括深静脉血栓和肺动脉栓塞。\n\n00:19.569 --> 00:27.669\n80岁以上老年人静脉血栓栓塞症发生率为每1000人6.8人每年。\n\n00:28.878 --> 00:31.479\n80岁以上住院患者的。\n\n00:32.933 --> 00:36.883\n静脉血栓栓塞症发生率达11.8。\n\n00:38.994 --> 00:40.194\n国内80岁。\n\n00:41.215 --> 00:47.165\n以上住院患者静脉血栓栓塞症发生率为13.3%。\n\n00:48.465 --> 00:48.590\n嗯，\n\n00:48.590 --> 00:49.465\n由此可见，\n\n00:49.465 --> 00:55.765\n国内外高龄老年人静脉血栓栓塞症形势同样严峻。\n\n00:58.599 --> 00:58.799\n首先，\n\n00:58.799 --> 01:00.900\n我们来探讨一下它的高危因素。\n\n01:02.180 --> 01:07.030\n以以下三种是会造成血栓栓塞危险因素增高。\n\n01:08.330 --> 01:08.580\n第一，\n\n01:08.580 --> 01:09.980\n血流瘀滞，\n\n01:10.430 --> 01:11.080\n第二，\n\n01:11.129 --> 01:12.230\n血液高凝，\n\n01:12.680 --> 01:13.254\n第三，\n\n01:13.254 --> 01:14.779\n血管内皮损伤。\n\n01:16.726 --> 01:20.626\n高龄卧床老人卧床时间延长超过三天，\n\n01:20.976 --> 01:24.726\n静脉血栓栓塞率、发生率风险显著增加，\n\n01:25.027 --> 01:27.527\n卧床超过7天以上的，\n\n01:28.327 --> 01:30.876\n风险发生率达到15%，\n\n01:31.177 --> 01:32.876\n卧床超过14天。\n\n01:34.332 --> 01:36.482\n发生率高达32%。\n\n01:36.632 --> 01:37.732\n由此可见，\n\n01:38.181 --> 01:39.757\n长期卧床患者，\n\n01:39.757 --> 01:45.332\n尤其是高龄患者必须高度重视血栓栓塞症的预防和监测。\n\n01:47.502 --> 01:51.203\n高危血栓栓塞症患者通常是指。\n\n01:52.125 --> 01:55.175\n合并多种血栓栓塞风险因素的个体，\n\n01:55.525 --> 02:01.349\n比如说长期卧床或者个人或家族血栓史并存，\n\n02:01.349 --> 02:05.525\n慢性疾病、近期手术或创伤，\n\n02:06.324 --> 02:09.850\n遗传性血栓倾向影响凝血，\n\n02:09.850 --> 02:12.125\n药物使用活动减少等。\n\n02:13.166 --> 02:17.416\n20岁以上高龄患者常伴多种慢性疾病，\n\n02:17.416 --> 02:29.815\n如心血管疾病、脑卒中、糖尿病等生理病理性肝肾功能减退导致的抗凝治疗安全和有效问题。\n\n02:30.466 --> 02:33.766\n约占60%的血栓栓塞症，\n\n02:34.016 --> 02:39.315\n尤其是膝上发展为血栓塞、静肺静脉血栓。\n\n02:40.229 --> 02:41.378\n分享显著升高，\n\n02:41.378 --> 02:43.479\n发生率达50%。\n\n02:43.979 --> 02:48.078\n膝下的血栓栓塞症如不及时核实处理，\n\n02:48.578 --> 02:50.003\n也可能向上扩展，\n\n02:50.003 --> 02:51.979\n导致肺静脉血栓。\n\n02:54.078 --> 02:54.828\n专家建议，\n\n02:55.177 --> 03:01.927\n80岁以上高龄卧床患者应高度重视血栓栓塞的风险，\n\n03:02.027 --> 03:03.128\n综合评估，\n\n03:03.578 --> 03:07.677\n并及时制定针对的监测和防治方案。\n\n03:08.628 --> 03:08.828\n嗯。\n\n03:09.869 --> 03:18.169\n以下我将从血栓栓塞症的风险评估、血栓栓塞症的诊断、防治及动态持续监测。\n\n03:19.483 --> 03:19.884\n阐述。\n\n03:22.311 --> 03:22.537\n嗯，\n\n03:22.537 --> 03:27.212\n血栓栓塞症的风险评估有早期评估和风险分级。\n\n03:28.583 --> 03:30.684\n和出血风险评估。\n\n03:33.188 --> 03:35.438\n早期评估和风险分级，\n\n03:35.639 --> 03:40.589\n通过患者的健康状况、疾病背景及卧床时间。\n\n03:42.356 --> 03:46.455\n来表述个性化血栓栓塞症防治策略，\n\n03:46.705 --> 03:50.055\n预期需要长期卧床的高龄患者。\n\n03:50.906 --> 03:59.207\n伴有骨折或术后康复患者采用K评分及P评分工具。\n\n04:02.044 --> 04:05.643\nKVT风险评分由危险因素。\n\n04:09.876 --> 04:10.376\n大家看，\n\n04:10.526 --> 04:10.852\n嗯，\n\n04:10.852 --> 04:14.477\n年龄41岁到60岁的患者，\n\n04:14.477 --> 04:16.076\n如果满足这些条件，\n\n04:16.076 --> 04:17.277\n将得一分。\n\n04:18.403 --> 04:19.204\n如败血症，\n\n04:19.253 --> 04:22.104\n在一个月内得过败血症小手术，\n\n04:22.303 --> 04:24.253\n症状明显的静脉曲张，\n\n04:24.553 --> 04:25.454\n肥胖，\n\n04:25.454 --> 04:27.403\nBMI大于三十，\n\n04:27.704 --> 04:28.803\n肺功能异常，\n\n04:29.204 --> 04:32.704\n下肢水肿或者是急性心肌梗塞。\n\n04:34.312 --> 04:37.363\n或者一个月内有过严重肺部疾病，\n\n04:37.363 --> 04:38.513\n包括肺炎，\n\n04:39.412 --> 04:42.863\n或者一个月内有充血性心力衰竭。\n\n04:44.075 --> 04:48.226\n妊娠期或产后炎性肠病及肾病综合征。\n\n04:49.697 --> 04:52.148\n不能解释或两次自然流产病史，\n\n04:52.747 --> 04:55.798\n或者口服避孕药或激素。\n\n04:55.898 --> 05:01.997\n激素替代治疗需要卧床休息的患者及静脉曲张手术时。\n\n05:04.334 --> 05:04.459\n嗯，\n\n05:04.459 --> 05:08.158\n危险因素得分两分的年龄是分层，\n\n05:08.158 --> 05:09.933\n是在61.74岁，\n\n05:10.283 --> 05:14.134\n或者是正在接受恶性肿瘤的治疗，\n\n05:14.634 --> 05:16.234\n或者关节镜手术，\n\n05:16.334 --> 05:19.484\n或者卧床是大于72小时。\n\n05:20.533 --> 05:23.234\n我的开放性手术大于45分钟，\n\n05:23.384 --> 05:28.084\n或者是石膏固定腹腔镜手术大于45分钟的。\n\n05:28.911 --> 05:34.860\n或者是由中央静脉导管或者脾切除史及其他大手术，\n\n05:35.010 --> 05:37.661\n既往是或者有过，\n\n05:37.661 --> 05:39.561\n血栓栓塞病史的。\n\n05:41.606 --> 05:46.006\n危险因素得3分的是大于等于75岁的患者。\n\n05:47.109 --> 05:51.309\n或者是有免疫抗核抗体的抗凝阳性啊，\n\n05:51.559 --> 05:53.660\n或者抗心磷脂抗体阳性，\n\n05:55.109 --> 05:58.660\n或者是有这种血栓栓塞家族史的患者。\n\n06:00.298 --> 06:03.847\n得分最高的好像还是在一个月内有过脑卒中，\n\n06:04.148 --> 06:06.947\n或者是全髋关节或膝关节置换。\n\n06:08.130 --> 06:10.679\n或者急性脊柱损伤的。\n\n06:13.190 --> 06:13.390\n嗯，\n\n06:13.589 --> 06:15.140\n最后评分之后，\n\n06:15.440 --> 06:16.890\n把这个总分相加。\n\n06:17.239 --> 06:19.589\n如果是零分的话，\n\n06:19.640 --> 06:22.890\n血栓栓塞发生率一般小于10%。\n\n06:23.239 --> 06:24.964\n那嘱患者尽早活动，\n\n06:24.964 --> 06:26.190\n获得基础预防。\n\n06:27.061 --> 06:29.911\n如果是低危风险一到两分的患者，\n\n06:30.110 --> 06:34.061\n那就是发生率大概是10%.20%。\n\n06:34.610 --> 06:34.936\n嗯，\n\n06:34.936 --> 06:35.811\n药物预防。\n\n06:36.704 --> 06:39.329\n加物理预防就够了，\n\n06:39.329 --> 06:41.505\n中危风险是3.4分，\n\n06:41.904 --> 06:45.505\n那血栓栓塞发生率是20%.40%。\n\n06:45.855 --> 06:47.954\n药物预防增加物理预防，\n\n06:47.954 --> 06:53.554\n所以低危和中危风险的基本上就是药物预防加物理预防。\n\n06:53.554 --> 06:54.704\n如果是高危患者，\n\n06:54.704 --> 06:58.755\n一般是算出来总分大于等于五分的发生率比较高，\n\n06:58.755 --> 07:00.704\n是40%.80%，\n\n07:00.704 --> 07:03.105\n死亡率是1%.5%，\n\n07:04.005 --> 07:06.855\n说继续从事药物。\n\n07:06.959 --> 07:09.783\n辅助治疗加物理预防的情况下，\n\n07:09.783 --> 07:14.058\n还要随访患者的鼻体风险评估得分，\n\n07:14.058 --> 07:15.259\n看看动态变化。\n\n07:16.727 --> 07:16.928\n嗯，\n\n07:16.977 --> 07:22.028\n此外还有改良性的量表，\n\n07:22.028 --> 07:26.828\n与那个前面我们说的VTE风险评分相较。\n\n07:28.963 --> 07:29.463\n差不多。\n\n07:31.273 --> 07:32.673\n大家快速过一下。\n\n07:36.165 --> 07:37.415\n嗯，\n\n07:37.415 --> 07:41.173\nPVTE风险评分是是相对简便的方法，\n\n07:41.173 --> 07:44.815\n是临床上相对用的比较多的啊，\n\n07:44.915 --> 07:47.415\n它是通过危险因素得分，\n\n07:47.415 --> 07:49.415\n一分两分3分相加。\n\n07:50.196 --> 07:51.920\n相对于前面的，\n\n07:51.920 --> 07:54.721\n它的选项比较少，\n\n07:54.821 --> 07:58.721\n就方便临床上快速快速给患者评分。\n\n08:00.324 --> 08:00.623\n嗯，\n\n08:00.674 --> 08:01.848\n除此之外，\n\n08:01.848 --> 08:02.223\n嗯，\n\n08:02.223 --> 08:04.449\n除了风险评估之外，\n\n08:04.449 --> 08:07.223\n还是要评估一下患者的出血风险。\n\n08:08.144 --> 08:10.794\n准确识别高出血风险患者，\n\n08:10.794 --> 08:12.919\n制定个性化的抗凝治疗。\n\n08:13.269 --> 08:14.044\n那比如说，\n\n08:14.044 --> 08:17.218\n围手术期大出血危险因素评估，\n\n08:17.519 --> 08:18.868\n围术期的患者，\n\n08:19.269 --> 08:19.669\n嗯，\n\n08:19.769 --> 08:22.019\nImprove出血评分。\n\n08:23.371 --> 08:23.471\n嗯，\n\n08:23.471 --> 08:25.971\n相对是评估内科住院患者。\n\n08:26.941 --> 08:28.066\n围术期大出血，\n\n08:28.066 --> 08:30.316\n出血评分一般。\n\n08:30.316 --> 08:31.516\n危险因素有，\n\n08:31.516 --> 08:45.091\n活动性出血、既往大出血、已知的未经治疗的出血疾病、严重肾和肝功能不全、血小板减少、急性脑卒中、未控制的全身性高血压，\n\n08:45.341 --> 08:52.992\n过去的4小时或未来的12小时内腰椎穿刺、硬膜外麻醉或蛛网膜下腔麻醉，\n\n08:53.192 --> 08:57.091\n同时使用抗凝溶栓药物及抗血板。\n\n08:57.205 --> 08:58.205\n血小板药物，\n\n08:58.405 --> 09:00.255\n特定的危险因素啊，\n\n09:00.255 --> 09:01.405\n腹部手术的，\n\n09:01.554 --> 09:03.255\n或者应用阿司匹林，\n\n09:03.304 --> 09:08.554\n术前三天内使用过氯吡格雷或者是胸部手术。\n\n09:11.921 --> 09:20.171\nImprove出血评分是通过患者的性别、肾小球滤过率及所患疾病或者年龄。\n\n09:21.189 --> 09:22.388\n等评估，\n\n09:22.588 --> 09:25.289\n高危风险一般是大于等于7。\n\n09:25.939 --> 09:30.638\n专家建议是预期卧床超过3天的所有高龄患者，\n\n09:31.039 --> 09:34.439\n首诊基因进行VT风险评估。\n\n09:35.119 --> 09:38.318\n应对所有患者进行出血风险评估，\n\n09:38.669 --> 09:42.268\n以指导个性化BT防治方案制定。\n\n09:42.718 --> 09:46.568\n应进行连续动态血栓及出血风险评估，\n\n09:46.818 --> 09:51.468\n以指导BTE防治方案相应调整。\n\n09:52.929 --> 09:54.153\n从VT的诊断啊，\n\n09:54.153 --> 09:55.804\n首首诊初步诊断，\n\n09:55.804 --> 09:58.479\n实验室检查及影像学检查。\n\n09:59.947 --> 10:01.146\n这几方面来阐述。\n\n10:03.833 --> 10:05.857\nBT的首诊初步诊断，\n\n10:05.857 --> 10:08.507\n临床检验前概率诊断评估，\n\n10:08.507 --> 10:15.033\n首诊医生接诊患者时未进行特殊仪器及检实验室检测情况下，\n\n10:15.182 --> 10:18.982\n结合患者的病史、临床表现及体格检查。\n\n10:20.109 --> 10:21.859\n进行概率诊断评估。\n\n10:23.544 --> 10:23.943\n嗯，\n\n10:23.943 --> 10:29.393\n你可以通过简化维尔斯评分法来评估患者的BT风险。\n\n10:30.523 --> 10:34.398\n实验室检查是最常见的诊断方法，\n\n10:35.148 --> 10:35.549\n嗯，\n\n10:35.549 --> 10:41.273\n检测患者的第二具体那该检测方法敏感性约为95%，\n\n10:41.273 --> 10:42.999\n特异性为43%，\n\n10:43.249 --> 10:46.098\n低概率的血栓栓塞风险患者中。\n\n10:47.049 --> 10:47.223\n第二，\n\n10:47.223 --> 10:49.299\n具体阴性具有排除意义。\n\n10:50.752 --> 10:52.502\n排除率可达97%，\n\n10:53.151 --> 10:58.202\n高龄患者采用年龄矫正的第二具体浓度作为诊断依据，\n\n10:58.351 --> 11:04.151\n推荐是年龄乘以10μg/L作为参考阈值。\n\n11:05.953 --> 11:10.953\n对于敏感概率较高的VT高度可能的患者，\n\n11:11.002 --> 11:15.328\n不仅不能仅通过第二具体水平排除BTE，\n\n11:15.328 --> 11:22.002\n应结合超声检测等措施或重复检测排除进行动态观察。\n\n11:22.624 --> 11:23.723\n在此临床上面，\n\n11:23.723 --> 11:27.148\n比如比如说下肢有静脉血栓的，\n\n11:27.148 --> 11:28.723\n或者动脉血栓的患者。\n\n11:29.747 --> 11:31.372\n可以排查下肢的血管。\n\n11:31.372 --> 11:31.848\nB超。\n\n11:33.302 --> 11:33.603\n嗯，\n\n11:33.603 --> 11:37.828\n相对于跟第二聚体水平做对比，\n\n11:38.028 --> 11:40.927\n从而来诊断是否有血栓形成。\n\n11:42.364 --> 11:44.914\n影像学检查就是彩色血管，\n\n11:44.914 --> 11:47.713\n多普勒超声是首选的诊断方法。\n\n11:49.486 --> 11:50.986\n临床高度怀疑的患者，\n\n11:50.986 --> 11:54.187\n需5.7天后进行超声复查，\n\n11:54.187 --> 11:58.086\n80岁以上高龄的患者需5.7天。\n\n11:59.692 --> 12:00.567\n进行复查，\n\n12:00.567 --> 12:01.091\n考虑，\n\n12:01.242 --> 12:01.591\n嗯，\n\n12:01.591 --> 12:05.692\n肺动考虑肺静脉血栓和肺动脉造影时，\n\n12:05.742 --> 12:07.841\n首先评估肾功能状况。\n\n12:08.594 --> 12:09.645\n不做优先推荐。\n\n12:10.544 --> 12:13.344\n以下是VTE的规范诊断流程。\n\n12:18.270 --> 12:22.921\n我们从大于等于2的患者的评分来说，\n\n12:23.120 --> 12:28.495\n下肢静脉血栓可以完善下肢静脉超声结果不能界定的，\n\n12:28.495 --> 12:32.145\n慎重选择肺动脉造影或者静脉造影，\n\n12:32.145 --> 12:33.296\n如果是阳性的，\n\n12:33.296 --> 12:36.320\n则诊断为这个DADBT。\n\n12:39.517 --> 12:39.692\nV,\n\n12:39.692 --> 12:40.442\n嗯，\n\n12:40.442 --> 12:41.666\nVTE的防治，\n\n12:41.666 --> 12:42.966\nVT的防治有多种。\n\n12:44.552 --> 12:45.328\n治疗手段，\n\n12:45.328 --> 12:46.953\n比如抗凝药物治疗，\n\n12:47.153 --> 12:48.153\n溶栓治疗，\n\n12:48.153 --> 12:48.877\n腔内治疗，\n\n12:48.877 --> 12:49.703\n压力治疗，\n\n12:49.903 --> 12:52.002\n恶性肿瘤合并VT防治。\n\n12:53.085 --> 12:55.385\n下肢孤立性远端的DVT。\n\n12:57.297 --> 13:04.047\n与T1的预防应尽早进行运动锻炼、机械性预防及抗凝药物预防，\n\n13:04.297 --> 13:06.898\n药物与机械方式联合预防。\n\n13:07.908 --> 13:10.833\n常用的抗凝药物及剂量选择啊，\n\n13:10.833 --> 13:14.307\n一般通过评估患者的疾病状态。\n\n13:15.502 --> 13:18.401\n确定适合性的急性期治疗方案。\n\n13:19.445 --> 13:23.570\n对于出血风险可控的VT高龄患者，\n\n13:23.570 --> 13:26.145\n建议早期启动抗凝治疗。\n\n13:27.581 --> 13:31.606\nVTE高风险卧床患者应优先考虑药物预防。\n\n13:33.101 --> 13:33.801\n如甘素。\n\n13:34.890 --> 13:37.289\n或者新型的口服抗凝药物。\n\n13:38.776 --> 13:43.026\n抗凝药物的治疗常用抗凝药物用法及用量推荐。\n\n13:44.166 --> 13:44.366\n嗯，\n\n13:44.815 --> 13:49.366\n目前我们临床上用的最多的是利伐沙班及艾多沙班。\n\n13:50.237 --> 13:51.862\n一般是二利法，\n\n13:51.862 --> 13:53.112\n沙班是20mg，\n\n13:53.112 --> 13:54.187\n每天一次。\n\n13:55.267 --> 13:55.341\n嗯，\n\n13:55.341 --> 13:57.166\n艾多沙班是60mg，\n\n13:57.317 --> 13:58.367\n每天一次。\n\n14:00.038 --> 14:02.538\n抗凝药物治疗及专家建议，\n\n14:02.937 --> 14:03.288\n嗯，\n\n14:03.288 --> 14:10.687\n高龄卧床无高出出血风险或者出血风险相对可控的高危BT患者，\n\n14:10.687 --> 14:12.687\n早期启动抗凝治疗。\n\n14:16.198 --> 14:16.598\n嗯，\n\n14:16.898 --> 14:23.299\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天以上。\n\n14:24.898 --> 14:29.598\n以下是通过华法林桥接或者是首次推荐。\n\n14:29.598 --> 14:31.148\n目前来说就是。\n\n14:32.174 --> 14:35.325\n新的治疗方案是VTE治疗指南的变迁。\n\n14:40.872 --> 14:41.072\n嗯，\n\n14:41.322 --> 14:42.572\n通过指南呢，\n\n14:42.572 --> 14:46.348\n哪些患者不需要延长抗凝治疗？\n\n14:46.348 --> 14:49.672\n长期复发风险是小于3%。\n\n14:49.672 --> 14:53.447\n每年的危险分危险因素分类，\n\n14:53.447 --> 14:57.223\n一过性的强危险因素或可逆性危险因素。\n\n15:01.127 --> 15:03.578\n决定VT抗凝持续时间的策略。\n\n15:10.512 --> 15:12.711\n在抗凝药物治疗疗程当中，\n\n15:13.111 --> 15:15.762\n非肿瘤患者推荐首先使用。\n\n15:17.716 --> 15:20.841\nDOAC进行3个月抗凝治疗，\n\n15:20.841 --> 15:22.617\n肿瘤患者推荐使用。\n\n15:24.591 --> 15:24.966\n那么，\n\n15:24.966 --> 15:26.791\n是长期抗凝治疗，\n\n15:27.242 --> 15:30.341\n专家建议常规抗凝疗程为3个月。\n\n15:30.692 --> 15:32.716\n基于永久性的危险因素，\n\n15:32.716 --> 15:36.341\n如恶性肿瘤或特发性血栓栓塞，\n\n15:36.341 --> 15:38.841\n并合并肺血栓栓塞。\n\n15:39.192 --> 15:39.517\n嗯，\n\n15:39.517 --> 15:43.075\n在综合评估血栓和出血风险后，\n\n15:43.075 --> 15:45.392\n决定是否延长抗凝。\n\n15:46.453 --> 15:47.754\n至6个月或更长。\n\n15:51.538 --> 15:53.463\n溶栓治疗专家建议，\n\n15:53.463 --> 15:55.237\n高龄血栓栓塞。\n\n15:56.286 --> 15:58.137\n不建议系统性溶栓治疗。\n\n15:58.187 --> 16:03.036\n中央型或混合型血栓栓塞及肺动脉栓塞患者，\n\n16:03.187 --> 16:06.687\n在出血风险较低或无绝对禁忌症时。\n\n16:08.030 --> 16:08.854\n应综合考虑，\n\n16:08.854 --> 16:11.929\n慎重考虑是否进行溶栓治疗。\n\n16:19.117 --> 16:21.617\n恶性肿瘤与血栓栓塞关系密切，\n\n16:21.666 --> 16:23.304\n无出血禁忌时，\n\n16:23.304 --> 16:29.666\n应对所有住院、卧床高龄恶性肿瘤患者进行血栓栓塞预防。\n\n16:30.919 --> 16:31.968\n推荐，\n\n16:31.968 --> 16:40.119\n用蓝本作为恶性肿瘤患者血栓栓塞、猝死和维维续治疗的首选药物。\n\n16:45.356 --> 16:49.231\n高龄患者中心静脉导管相关性的血栓防治，\n\n16:49.231 --> 16:54.356\n使高龄患者留置中心静脉导管是血栓栓塞危险因素之一，\n\n16:54.606 --> 16:57.606\n不推荐常用预防性抗凝治疗。\n\n16:57.656 --> 17:02.831\n明确诊断为导管相关的血栓栓塞患者不推荐常规拔除。\n\n17:02.831 --> 17:06.756\n保留导管期间需持续抗凝3个月，\n\n17:06.906 --> 17:10.207\n必须拔出前需充分抗凝3.7天，\n\n17:10.457 --> 17:12.506\n拔除后继续抗凝3个月。\n\n17:13.724 --> 17:18.599\n骨科大手术合并的血栓栓塞防治如无禁忌症，\n\n17:18.599 --> 17:22.625\n应尽早采用药物及物理方法预防血栓。\n\n17:22.925 --> 17:27.875\n那大手术患者预防期限应延长至术后的35天。\n\n17:32.048 --> 17:32.173\n嗯，\n\n17:32.173 --> 17:34.448\n此外还需动态持续监测。\n\n17:36.505 --> 17:36.604\n嗯，\n\n17:36.604 --> 17:38.704\n定期监测患者的下肢情况，\n\n17:38.954 --> 17:40.104\n如体格检查，\n\n17:40.255 --> 17:43.180\n然后动态完善相关辅助检查，\n\n17:43.180 --> 17:45.555\n如第二聚体及血管超声。\n\n17:45.954 --> 17:48.479\n定期检测凝血相关指标，\n\n17:48.479 --> 17:51.055\n如凝血五项、血小板等，\n\n17:51.155 --> 17:52.905\n评估出血的风险。\n\n17:53.405 --> 17:58.305\n那如果PT延长超过正常上限的1.5倍时，\n\n17:58.305 --> 18:01.055\nAPTT延长超过正常上限的1.5倍。\n\n18:01.767 --> 18:04.917\n应考虑减少或暂停抗凝药物使用，\n\n18:05.067 --> 18:08.868\n若血小板小于50×10的9次方每升，\n\n18:09.218 --> 18:11.567\n应考虑停用肝素类药物，\n\n18:11.618 --> 18:17.567\n并根据个体化评估改用其他肝素类抗凝或预防措施。\n\n18:19.930 --> 18:21.704\n在VTE防治期间，\n\n18:21.704 --> 18:26.829\n应动态监测患者临床表现及实验室指标监测，\n\n18:27.130 --> 18:30.030\n定期进行血管超声等辅助检查，\n\n18:30.079 --> 18:32.229\n动态调整防治方案。\n\n18:33.166 --> 18:38.066\n总结高龄卧床高危患者的静脉血栓栓塞症，\n\n18:38.416 --> 18:43.615\n早期评估、风险分级以及出血风险评估至关重要。\n\n18:44.593 --> 18:45.593\n临床检测前。\n\n18:47.329 --> 18:50.180\n概率诊断评估是VTE诊断的关键。\n\n18:50.180 --> 18:50.780\n第一步，\n\n18:51.030 --> 18:51.680\n疑似。\n\n18:52.713 --> 18:58.363\n血栓栓塞及肺血栓栓塞高龄患者应通过简化V评分，\n\n18:58.363 --> 19:02.713\n结合年龄校正的第二具体进入临床诊断评估流程。\n\n19:03.506 --> 19:11.957\n血栓栓塞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\n19:13.031 --> 19:14.181\n高龄住院患者，\n\n19:14.181 --> 19:29.380\n如内科重症慢病患者、骨科多种疾病患者、重症监护病房、肿瘤及手术后患者群体是血栓栓塞症高发人群，\n\n19:29.681 --> 19:32.531\n防治方案选择应个体化。\n\n19:33.409 --> 19:33.708\n此外，\n\n19:33.708 --> 19:40.958\n需动态监测临床表现及相关检验检查指标及动态调整防治方案，\n\n19:41.308 --> 19:42.259\n谢谢大家。\n\n","v0d47cg10004d60s7caljhtcqbn0pet0",1184,1613,"2026-01-24 21:52:03","高龄卧床高危静脉血栓栓塞症预防与护理指南  ","高龄卧床,静脉血栓栓塞症,高危人群,血栓预防,卧床护理,深静脉血栓,肺栓塞  ","本文详细介绍高龄卧床患者静脉血栓栓塞症的高危因素、预防措施及科学护理方法，帮助降低深静脉血栓和肺栓塞风险，提升卧床患者生活质量。","2026-04-02 19:30:00",[37],{"menuId":38,"menuName":39,"parentId":17,"orderNum":22,"path":40,"component":41,"isFrame":42,"isCache":43,"menuType":44,"visible":26,"status":17,"createDept":6,"remark":24,"createTime":45,"children":46,"columnImage":47,"columnLogo":48,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":49,"seoKeywords":50,"seoDescription":51,"contentNum":6,"promotionalPoster":52,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":53,"routerPath":40,"componentInfo":41},"1986622624134549505","科普视频","video","/video.html","1","0","T","2025-11-07 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