美国医师学院的临床实践指南住院患者静脉血栓的预防.docx
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美国医师学院的临床实践指南住院患者静脉血栓的预防
从美国医师学院的临床实践指南:
住院患者静脉血栓的预防。
BibliographicSource(s)书目来源(S)
QaseemA,ChouR,HumphreyLL,StarkeyM,ShekelleP,fortheClinicalGuidelinesCommitteeoftheAmericanCollegeofPhysicians.一个qaseem,周ŕ,汉弗莱的LL,斯塔基男,Shekelle带够,美国医师学院的临床指引委员会。
Venousthromboembolismprophylaxisinhospitalizedpatients:
aclinicalpracticeguidelinefromtheAmericanCollegeofPhysicians.从美国医师学院的临床实践指南:
住院患者静脉血栓的预防。
AnnInternMed2011Nov1;155(9):
625-32.安内科杂志2011年11月1日;155(9):
625-32。
[50references]PubMed[50]期刊
GuidelineStatus指引状态
Thisisthecurrentreleaseoftheguideline.这是当前版本的指引。
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Scope范围
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Methodology方法论
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Recommendations建议
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EvidenceSupportingtheRecommendations证据支持的建议
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Benefits/HarmsofImplementingtheGuidelineRecommendations实施指引建议的好处/危害
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QualifyingStatements资格声明
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ImplementationoftheGuideline该指引的执行情况
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InstituteofMedicine(IOM)NationalHealthcareQualityReportCategories国家医学研究所(IOM)医疗质量报告分类
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IdentifyingInformationandAvailability确定信息和可用性
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Disclaimer免责声明
Developer:
AmericanCollegeofPhysicians开发商:
美国医师学院
AgeofTargetPopulation:
Adult(19to44years);Aged(65to79years);Aged,80andover;MiddleAge(45to64years)目标人群:
成人(19至44岁),老年人(65岁至79岁),老年人,80以上;中世纪(45至64岁年龄)
UMLSConcepts(what'sthis?
)UMLS的概念(这是什么?
)
Clicktoviewallguideline(s)indexedwiththeseconcepts点击查看所有准则(S)与这些概念索引
ICD9CM:
Acutevenousembolismandthrombosisofunspecifieddeepvesselsoflowerextremity(453.40);Chronicvenousembolismandthrombosisofunspecifieddeepvesselsoflowerextremity(453.50);Otherpulmonaryembolismandinfarction(415.19)ICD9CM:
不详下肢深静脉血栓形成急性静脉栓塞(453.40);慢性静脉栓塞,不明下肢深静脉血栓形成(453.50);其他肺栓塞和梗死(415.19)
MSH:
PulmonaryEmbolism;VenousThromboembolism;VenousThrombosisMSH的肺栓塞,静脉血栓静脉血栓形成
MTH:
DeepVeinThrombosis;PulmonaryEmbolism;VenousThrombosis跖骨:
深静脉血栓形成,肺栓塞,静脉血栓形成
PDQ:
fondaparinuxsodium;heparin;thromboembolismPDQ的:
fondaparinux的钠;肝素;血栓
SNOMEDCT:
Deepvenousthrombosis(16750002);Pulmonaryembolism(59282003);Venousthrombosis(111293003)SNOMEDCT:
深静脉血栓形成(16750002);肺栓塞(59282003);静脉血栓形成(111293003)
SPN:
HEPARIN;LEGGING,COMPRESSION,NON-INFLATABLE的SPN:
肝素的legging,压缩,非充气
UMD:
CirculatoryAssistUnits,PeripheralCompression,Sequential,End-Diastolic(18-085);Stockings,Compression(13-789)UMD格式:
循环辅助单元,外围压缩,连续,舒张末期(18-085);长袜,压缩(13-789)
Showall...显示所有...
ICD9CM:
Acutevenousembolismandthrombosisofunspecifieddeepvesselsoflowerextremity(453.40);Chronicvenousembolismandthrombosisofunspecifieddeepvesselsoflowerextremity(453.50);Embolismandthrombosisofunspecifiedsite(453.9);Hemorrhage,unspecified(459.0);Otherpulmonaryembolismandinfarction(415.19)ICD9CM:
不详下肢深静脉(453.40);慢性静脉栓塞和血栓形成下肢不明深船只(453.50);急性静脉栓塞和血栓栓塞和血栓形成的未指定网站(453.9);出血,不明(459.0)其他肺栓塞和梗死(415.19)
MSH:
Hemorrhage;Heparin;Heparin,Low-Molecular-Weight;IntermittentPneumaticCompressionDevices;Polysaccharides;PulmonaryEmbolism;RiskAssessment;Stockings,Compression;Thromboembolism;ThrombolyticTherapy;VenousThromboembolism;VenousThrombosisMSH的出血;肝素肝素,低分子量;间歇充气加压装置;多糖;肺栓塞;风险评估;长袜,压缩;血栓;溶栓治疗静脉血栓栓塞静脉血栓形成
MTH:
CompressionStockings;DeepVeinThrombosis;Fondaparinuxsodium;Hemorrhage;Heparin;Heparin,Low-Molecular-Weight;Polysaccharides;PulmonaryEmbolism;Thromboembolism;VenousThrombosis跖骨:
压缩长袜;深静脉血栓形成;使用Fondaparinux钠;出血;肝素,肝素,低分子量多糖,肺栓塞,血栓静脉血栓形成
PDQ:
fondaparinuxsodium;heparin;thromboembolism;thrombolytictherapyPDQ的:
磺达肝素钠;;血栓;溶栓治疗
SNOMEDCT:
Deepvenousthrombosis(128053003);Deepvenousthrombosis(16750002);Fondaparinuxsodium(385517000);GraduatedcompressionelasticSNOMEDCT:
深静脉血栓形成(128053003);深静脉血栓形成(16750002);使用Fondaparinux钠(385517000);毕业于压缩弹性molecularweightheparin(373294004);Lowmolecularweightheparin(87233003);Polysaccharide(71544008);Pulmonaryembolism(59282003);Riskassessment(225338004);Thromboembolicdisorder(13713005);Thromboembolicdisorder(371039008);Thrombolytictherapy(426347000);Venousthrombosis(111293003)低分子肝素(373294004);低分子量肝素(87233003);多糖(71544008);肺栓塞(59282003);风险评估(225338004);血栓栓塞性疾病(13713005);血栓栓塞性疾病(371039008);溶栓治疗(426347000);静脉血栓(111293003)
SPN:
HEPARIN;LEGGING,COMPRESSION,NON-INFLATABLE的SPN:
肝素的legging,压缩,非充气
UMD:
CirculatoryAssistUnits,PeripheralCompression,Sequential,End-Diastolic(18-085);Stockings,Compression(13-789)UMD格式:
循环辅助单元,外围压缩,连续,舒张末期(18-085);长袜,压缩(13-789)
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Viewallguidelinesummariesbythedeveloper(s):
AmericanCollegeofPhysicians由开发商(S)的所有指导方针摘要:
美国医师学院
Viewtheoriginal(fulltext)guideline原准则(全文)
(8pages)(8页)
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Scope范围
Disease/Condition(s)疾病/条件(S)
Venousthromboembolism,including:
静脉血栓,包括:
∙Pulmonaryembolism(PE)肺栓塞(PE)
∙Deepvenousthrombosis(DVT)下肢深静脉血栓(DVT)
GuidelineCategory指引类别
AssessmentofTherapeuticEffectiveness评估治疗成效
Prevention预防
RiskAssessment风险评估
ClinicalSpecialty临床专科
Cardiology心脏病
CriticalCare重症监护
FamilyPractice家庭实践
Geriatrics老年病学
Hematology血液学
InternalMedicine内科
Neurology神经内科
PreventiveMedicine预防医学
PulmonaryMedicine肺科
IntendedUsers目标用户
AdvancedPracticeNurses高级实践护士
Hospitals医院
Nurses护士
PhysicianAssistants助理医师
Physicians医生
GuidelineObjective(s)目的指引(S)
Topresentclinicalrecommendationsonprophylaxisofvenousthromboembolism(VTE)inadulthospitalizedmedicalpatientsandpatientswithacutestroke,basedontheavailableevidenceonthebenefitsandharmsofprophylaxisofVTEinthesepatientpopulations成人住院医疗患者和急性脑卒中患者VTE预防治疗的好处和危害,在这些患者人群提供证据的基础上,提出预防静脉血栓(VTE)的临床建议
TargetPopulation目标人群
Adulthospitalizednonsurgicalpatients(medicalpatientsandpatientswithacutestroke)whoareatriskforvenousthromboembolism成人住院静脉血栓风险的非手术治疗的患者(医疗患者与急性脑卒中患者)
InterventionsandPracticesConsidered考虑干预措施和做法
1.Assessmentoftheriskforthromboembolismandbleedingpriortoinitiationofprophylaxisofvenousthromboembolism血栓的风险评估和出血静脉血栓的预防开始前
2.Venousthromboembolismprophylaxis:
静脉血栓栓塞的预防:
∙Low-doselow-molecular-weightheparin(LMWH)低剂量低分子量肝素(LMWH)
∙Low-doseunfractionatedheparin(UFH)低剂量普通肝素(UFH)
∙Relatedagents(eg,fondaparinux)相关剂(如磺达)
∙Graduatedcompressionstockingsorothermechanicalcompression(notrecommended)毕业压缩丝袜或其他机械压缩(不推荐)
MajorOutcomesConsidered考虑的主要结果
∙Totalmortalityupto120daysafterrandomization总死亡率达120天之后随机
∙Incidenceofsymptomaticdeepvenousthrombosis(DVT)发病症状的下肢深静脉血栓形成(DVT)
∙Totalincidenceofpulmonaryembolisms(PEs)肺动脉栓塞的总发病率(PES)
∙IncidenceoffatalPE致命性PE的发病率
∙Incidenceofallbleedingevents所有出血事件发生率
∙Incidenceofmajorbleedingevents(variablydefinedbytrials,buttypicallydefinedasadecreaseinhemoglobinlevel>20g/L,transfusionof≥2unitsofblood,orlife-threateningbleedingatacriticalsite)主要出血事件发生率(可变定义的试验,但通常定义为血红蛋白水平下降>20g/L的,在关键部位≥2个单位的血液,或危及生命的出血输血)
∙Effectsofmechanicalprophylaxisonskin机械预防皮肤上的影响
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Methodology方法论
MethodsUsedtoCollect/SelecttheEvidence用来收集/选择证据的方法
Hand-searchesofPublishedLiterature(PrimarySources)手工检索发表的文献(主要来源)
Hand-searchesofPublishedLiterature(SecondarySources)发表的文献手工检索(中学源)
SearchesofElectronicDatabases搜索的电子数据库
DescriptionofMethodsUsedtoCollect/SelecttheEvidence描述的方法来收集/选择的证据
ThesystematicevidencereviewwasconductedbytheMinnesotaEvidence-basedPracticeCenter(seethe"AvailabilityofCompanionDocuments"field).明尼苏达循证实践中心(见“伴侣文件可用性”字段)系统的证据进行了审查。
TheliteraturesearchincludedstudiesidentifiedbyusingMEDLINEandtheCochraneLibraryforclinicaltrialsofvenousthromboembolism(VTE)prophylaxis.文献检索包括通过MEDLINE和Cochrane图书馆静脉血栓(VTE)预防的临床试验确定的研究。
Theauthorsreviewedtitlesandabstractsofidentifiedreferencesandusedreferencelistsofpertinentrandomizedtrialsandsystematicreviewstoidentifyadditionalreports.提交审查确定引用的标题和摘要,并使用相关的随机对照试验和系统评价的参考名单,以确定其他报告。
ThestudiesselectedincludedEnglish-language,randomizedtrialspublishedbetween1950andApril2011.该研究选取包括英语,1950年和2011年4月间发表的随机试验。
IncludedtrialsevaluatedtreatmentsthatarecommonlyrecommendedandusedtopreventVTE,includingsubcutaneouslow-dose(<20000U/d)unfractionatedheparin(UFH)orsimilarprophylacticdosesoflow-molecular-weightheparin(LMWH)orrelatedagents(suchasfondaparinux)andgraduatedcompressionstockingsorothermechanicalmeasures(suchasintermittentpneumaticcompression).纳入试验进行评估,包括皮下低剂量普通肝素(UFH)(<20000U/D)或类似的预防性剂量低分子量肝素(LMWH)或相关代理通常推荐用于预防VTE的治疗,(如磺达)和毕业加压袜或其他机械措施(如间歇充气加压)。
NumberofSourceDocuments数源文件
Notstated没有说明
MethodsUsedtoAssesstheQualityandStrengthoftheEvidence用于评估证据的质量和强度的方法
WeightingAccordingtoaRatingScheme(SchemeGiven)加权据评级计划(计划鉴于)
RatingSchemefortheStrengthoftheEvidence证据的证明力的评价计划
ThisguidelineratestheevidenceandrecommendationsbyusingtheguidelinegradingsystemoftheAmericanCollegeofPhysicians(ACP),whichisbasedontheGradingofRecommendationsAssessment,Development,andEvaluation(GRADE)system(seethe"RatingSchemefortheStrengthoftheRecommendations"field).本指引率的证据,并通过美国医师学院(ACP),这是建议的评估,开发和评价系统(一级)分级(见“评价计划的实力为基础的方针,分级制度的建议建议“栏)。
MethodsUsedtoAnalyzetheEvidence用来分析证据的方法
SystematicReviewwithEvidenceTables系统性回顾与证据表
DescriptionoftheMethodsUsedtoAnalyzetheEvidence用来分析证据的方法说明
Toguidetherecommendations,theauthorsprioritizedoutcomesonthebasisofclinicalimportance,startingwithtotalmortality.指导建议,在临床上的重要性的基础上优先的结果,总死亡率开始。
Intheabsenceofstatisticallysignificanteffectsontotalmortality,theauthorsthenweightedeffectsonallpulmonary