抄録
Although the prevention of pulmonary embolism is critical during the perioperative period, achieving a zero-rate of postoperative venous thrombosis is difficult, even with preventive measures. According to European and American reports, thrombosis occurs in 1% to 2% of patients, despite preventive measures. In this study, we prospectively implemented various preventive measures for postoperative venous thrombosis and compared the effects of these measures to determine the most effective measures.
The subjects (a total of 2, 222) were all of the patients who underwent surgery between January 2002 and June 2007, except for those who were pregnant. Of these, 411 patients who underwent surgery during 2002 did not receive any preventive measures, and these patients were considered the control group (Group A) . One hundred and ninety-one patients who underwent surgery between January and July 2003 received preventive measures that were determined based on their risk grades using the Risk grade-preventive measures table (Group B) . Elastic stockings and intermittent pneumatic compression (IPC) were used in all patients in this group. In 1, 620 patients who underwent surgery between July 2003 and June 2007, D-dimer was measured before surgery, and the Risk grade-preventive measures table was used (Group C) . If the D-dimer level exceeded 0.5 μg/mL, ultrasonography of the lower extremities was performed to check for the presence of deep vein thrombosis (DVT) . For patients in whom DVT was identified prior to surgery, IPC was not used. The three groups were compared with respect to the incidence of postoperative pulmonary embolism and the incidence of shock.
Postoperative pulmonary embolism was observed in 0.7% of patients in Group A, but it was observed in 3.1% of patients in Group B, which was significantly higher. The incidence in Group C was 0.06%, which was significantly lower than Groups A and B. Shock was observed in 0.5% of patients in Group A, but there was no case of shock in Group B or C.
Some patients in Group B had asymptomatic DVT, and IPC was used in those patients. As a result, in each case the thrombus was dislodged and carried through the bloodstream, causing pulmonary embolism. As such, in Group C D-dimer was measured in all patients prior to surgery, and ultrasonography of the lower extremities was performed in those who had a D-dimer level higher than the standard. For patients who had DVT prior to surgery, IPC was not used, and anticoagulant therapy was conducted prior to and following surgery. These preoperative and postoperative measures significantly reduced the incidence of thrombosis during the observation period, which indicates that our preventive measures are very effective.
