NCCN癌症相关性静脉血栓栓塞症防治指南(2020版)解读
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1.中南大学湘雅医院,药学部,湖南 长沙410008;2.中南大学湘雅医院,呼吸与危重症科,湖南 长沙410008;3.中南大学湘雅医院,护理部,湖南 长沙410008;4.中南大学湘雅医院,血管外科,湖南 长沙410008

作者简介:

戴婷婷,中南大学湘雅医院主管药师,主要从事血栓性疾病防治方面的研究。

基金项目:

湖南省自然科学基金资助项目(2021JJ80019)。


Interpretation of the 2020 NCCN guidelines for cancer-associated venous thromboembolic disease
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1.Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China;2.Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China;3.Department of Nursing, Xiangya Hospital, Central South University, Changsha 410008, China;4.Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

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    摘要:

    2020年4月,美国国家综合癌症网络(NCCN)发布了癌症相关性静脉血栓栓塞性疾病(VTE)指南2020年第1版。指南主要对住院及门诊癌症患者如何进行VTE的预防和治疗提供了指导建议。笔者重点将2020版与2019版NCCN指南内容进行对比,同时结合临床实际问题,对更新的VTE风险评估方法和防治措施的内容进行解读,以期相关医务工作者能更好地理解和遵循指南。

    Abstract:

    In April 2020, the National Comprehensive Cancer Network (NCCN) released the first edition of the 2020 guidelines for cancer-associated venous thromboembolic disease (VTE). The guidelines mainly provide recommendations on how to prevent and treat VTE for cancer patients in inpatient and outpatient settings. Here, the authors focus on the comparison between the 2020 edition and the 2019 edition of NCCN guidelines, and interpret the updated risk assessment methods and prevention and treatment measures of VTE combined with clinical practical problems, so as to help the relevant medical workers to better understand and follow the guidelines.

    表 1 依诺肝素用于血小板减少症患者的治疗用剂量选择Table 1 Dose selection of enoxaparin for the treatment of thrombocytopenia
    图1 癌症住院患者VTE预防Fig.1 VTE prophylaxis in cancer inpatients
    图2 出院/门诊癌症患者的VTE预防方法 注:1)高危腹部或盆腔手术患者包括胃肠道恶性肿瘤手术、既往VTE史、麻醉时间超过2 h、卧床≥4 d、晚期肿瘤及年龄>60岁的患者Fig.2 Prevention of VTE in discharged/outpatient cancer patients Note: 1) High-risk patients undergoing abdominal or pelvic surgery including those with surgery for gastrointestinal malignancy, previous history of VTE, anesthesia time longer than 2 h, bedridden status ≥4 d, cancer at advanced stage and age >60 years old
    图3 接受免疫调节药物的MM患者的VTE预防Fig.3 VTE prophylaxis in MM patients receiving immunomodulatory agents
    图4 急性SVT的检查和治疗方法Fig.4 Examination and treatment of acute SVT
    图5 癌症患者急性DVT的治疗方法Fig.5 Treatment of acute DVT in cancer patients
    图6 癌症患者急性PE的治疗方法Fig.6 Treatment of acute PE in cancer patients
    图7 癌症患者SPVT的治疗 注:1)导管溶栓需注意患者是否有溶栓禁忌证;2)经颈静脉肝内门腔静脉分流术(TIPS)Fig.7 Treatment of SPVT in cancer patients Note: 1) Paying attention to whether the patient has contraindications to thrombolytic therapy; 2) Transjugular intrahepatic portosystemic shunt (TIPS)
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戴婷婷,尹桃,黄琪,唐勇军,贺爱兰,黄建华. NCCN癌症相关性静脉血栓栓塞症防治指南(2020版)解读[J].中国普通外科杂志,2021,30(12):1387-1394.
DOI:10.7659/j. issn.1005-6947.2021.12.001

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  • 收稿日期:2020-12-25
  • 最后修改日期:2021-11-21
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  • 在线发布日期: 2022-01-07