{"id":17532,"date":"2019-08-08T05:14:39","date_gmt":"2019-08-07T21:14:39","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17532"},"modified":"2019-08-28T22:50:59","modified_gmt":"2019-08-28T14:50:59","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%a5%e9%87%8d%e5%88%9b%e4%bc%a4%e6%82%a3%e8%80%85%e6%94%be%e7%bd%ae%e8%85%94%e9%9d%99%e8%84%89%e6%bb%a4%e5%99%a8%e7%9a%84%e5%a4%9a%e4%b8%ad","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17532","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u4e25\u91cd\u521b\u4f24\u60a3\u8005\u653e\u7f6e\u8154\u9759\u8109\u6ee4\u5668\u7684\u591a\u4e2d\u5fc3\u7814\u7a76"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

A Multicenter Trial of Vena Cava Filters in Severely Injured Patients<\/h1>\n\n\n\n

Kwok M. Ho, Sudhakar Rao, Stephen Honeybul, et al<\/h3>\n\n\n\n

N Engl J Med 2019; 381:328-337
DOI: 10.1056\/NEJMoa1806515<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h3>\n\n\n\n

Whether early placement of an inferior vena cava filter reduces the risk of pulmonary embolism or death in severely injured patients who have a contraindication to prophylactic anticoagulation is not known.<\/p>\n\n\n\n

\u5bf9\u4e8e\u5177\u6709\u9884\u9632\u6027\u6297\u51dd\u7981\u5fcc\u7684\u4e25\u91cd\u521b\u4f24\u60a3\u8005\uff0c\u65e9\u671f\u7f6e\u5165\u4e0b\u8154\u9759\u8109\u6ee4\u5668\u80fd\u5426\u964d\u4f4e\u80ba\u52a8\u8109\u6813\u585e\u6216\u6b7b\u4ea1\u98ce\u9669\u5c1a\u4e0d\u660e\u786e\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h3>\n\n\n\n

In this multicenter, randomized, controlled trial, we assigned 240 severely injured patients (Injury Severity Score >15 [scores range from 0 to 75, with higher scores indicating more severe injury]) who had a contraindication to anticoagulant agents to have a vena cava filter placed within the first 72 hours after admission for the injury or to have no filter placed. The primary end point was a composite of symptomatic pulmonary embolism or death from any cause at 90 days after enrollment; a secondary end point was symptomatic pulmonary embolism between day 8 and day 90 in the subgroup of patients who survived at least 7 days and did not receive prophylactic anticoagulation within 7 days after injury. All patients underwent ultrasonography of the legs at 2 weeks; patients also underwent mandatory computed tomographic pulmonary angiography when prespecified criteria were met.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u591a\u4e2d\u5fc3\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u4e2d\uff0c\u6211\u4eec\u5c06240\u540d\u6709\u6297\u51dd\u836f\u7269\u7981\u5fcc\u7684\u4e25\u91cd\u521b\u4f24\uff08ISS\u8bc4\u5206> 15\u5206[\u5206\u503c0-75\uff0c\u5206\u503c\u8d8a\u9ad8\u521b\u4f24\u8d8a\u4e25\u91cd]\uff09\u60a3\u8005\u968f\u673a\u5206\u7ec4\uff0c\u5728\u56e0\u521b\u4f24\u5165\u9662\u540e\u6700\u521d72\u5c0f\u65f6\u5185\u7f6e\u5165\u8154\u9759\u8109\u6ee4\u5668\uff0c\u6216\u4e0d\u653e\u7f6e\u6ee4\u5668\u3002\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u5165\u9009\u540e90\u5929\u5185\u6709\u75c7\u72b6\u7684\u80ba\u52a8\u8109\u6813\u585e\u6216\u5168\u56e0\u6b7b\u4ea1\uff1b\u6b21\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u5b58\u6d3b\u81f3\u5c117\u5929\u4e14\u6700\u521d7\u5929\u5185\u672a\u63a5\u53d7\u9884\u9632\u6027\u6297\u51dd\u7684\u60a3\u8005\u4e9a\u7ec4\u7b2c8\u5929\u81f3\u7b2c90\u5929\u6709\u75c7\u72b6\u80ba\u52a8\u8109\u6813\u585e\u3002\u6240\u6709\u60a3\u8005\u57282\u5468\u65f6\u5747\u8fdb\u884c\u4e0b\u80a2\u8d85\u58f0\u68c0\u67e5\uff1b\u6ee1\u8db3\u9884\u5148\u786e\u5b9a\u6807\u51c6\u7684\u60a3\u8005\u5fc5\u987b\u63a5\u53d7CT\u80ba\u52a8\u8109\u9020\u5f71\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h3>\n\n\n\n

The median age of the patients was 39 years, and the median Injury Severity Score was 27. Early placement of a vena cava filter did not result in a significantly lower incidence of symptomatic pulmonary embolism or death than no placement of a filter (13.9% in the vena cava filter group and 14.4% in the control group; hazard ratio, 0.99; 95% confidence interval [CI], 0.51 to 1.94; P=0.98). Among the 46 patients in the vena cava filter group and the 34 patients in the control group who did not receive prophylactic anticoagulation within 7 days after injury, pulmonary embolism developed in none of those in the vena cava filter group and in 5 (14.7%) in the control group, including 1 patient who died (relative risk of pulmonary embolism, 0; 95% CI, 0.00 to 0.55). An entrapped thrombus was found in the filter in 6 patients.<\/p>\n\n\n\n

\u60a3\u8005\u4e2d\u4f4d\u5e74\u9f8439\u5c81\uff0cISS\u8bc4\u5206\u4e2d\u4f4d\u6570\u4e3a27\u5206\u3002\u4e0e\u4e0d\u653e\u7f6e\u6ee4\u5668\u76f8\u6bd4\uff0c\u65e9\u671f\u653e\u7f6e\u8154\u9759\u8109\u6ee4\u5668\u4e0d\u80fd\u51cf\u5c11\u6709\u75c7\u72b6\u80ba\u52a8\u8109\u6813\u585e\u6216\u6b7b\u4ea1\uff08\u8154\u9759\u8109\u6ee4\u5668\u7ec413.9%\uff0c\u5bf9\u7167\u7ec414.4%\uff1b\u98ce\u9669\u6bd4\uff0c0.99; 95% \u53ef\u4fe1\u533a\u95f4 [CI], 0.51 to 1.94; P=0.98\uff09\u3002\u8154\u9759\u8109\u6ee4\u5668\u7ec446\u540d\u60a3\u8005\u53ca\u5bf9\u7167\u7ec434\u540d\u60a3\u8005\u521b\u4f24\u540e7\u5929\u5185\u672a\u63a5\u53d7\u9884\u9632\u6027\u6297\u51dd\uff0c\u8154\u9759\u8109\u7ec4\u6ca1\u6709\u60a3\u8005\u53d1\u751f\u80ba\u52a8\u8109\u6813\u585e\uff0c\u5bf9\u7167\u7ec45\u540d\u60a3\u8005(14.7%)\u53d1\u751f\u80ba\u52a8\u8109\u6813\u585e\uff0c\u5305\u62ec1\u540d\u60a3\u8005\u6b7b\u4ea1\uff08\u80ba\u6813\u585e\u76f8\u5bf9\u5371\u9669\u5ea6\uff0c0; 95% CI, 0.00 to 0.55\uff09\u30026\u540d\u60a3\u8005\u7684\u6ee4\u5668\u4e0a\u53d1\u73b0\u8840\u6813\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS \u7ed3\u8bba<\/h3>\n\n\n\n

Early prophylactic placement of a vena cava filter after major trauma did not result in a lower incidence of symptomatic pulmonary embolism or death at 90 days than no placement of a filter.<\/p>\n\n\n\n

\u4e0e\u4e25\u91cd\u521b\u4f24\u540e\u4e0d\u653e\u7f6e\u6ee4\u5668\u76f8\u6bd4\uff0c\u65e9\u671f\u9884\u9632\u6027\u653e\u7f6e\u8154\u9759\u8109\u6ee4\u5668\u4e0d\u80fd\u51cf\u5c1190\u5929\u5185\u6709\u75c7\u72b6\u80ba\u52a8\u8109\u6813\u585e\u6216\u6b7b\u4ea1\u3002<\/p>\n\n\n\n

(Funded by the Medical Research Foundation of Royal Perth Hospital and others; Australian New Zealand Clinical Trials Registry number, ACTRN12614000963628<\/a>.)<\/p>\n\n\n\n

\u8bc4\u8bba[\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9]<\/h3>\n\n\n\n
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      ORIGINAL ARTICLE A Multicenter Trial of Vena Cava Filte […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17532"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17532"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17532\/revisions"}],"predecessor-version":[{"id":17546,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17532\/revisions\/17546"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17532"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17532"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17532"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}