赵 政,侯 明

背景：静脉血栓栓塞(VTE)是自发性脑出血(ICH)最常见和最可预防的并发症之一，住院期间深静脉血栓栓塞症与患者预后不良独立相关。方法：采用EMBASE、PubMed、Cochrane Library数据库对自发性脑出血后静脉血栓栓塞患者进行综合文献检索。我们检索了以下术语来确定相关研究（包括但不限于）:脑出血、脑出血、脑实质内出血、静脉血栓栓塞、静脉血栓栓塞、深静脉血栓形成、DVT、肺栓塞和PE。检索仅限于人类受试者，并且仅限于用英语发表的文章。对摘要进行筛选，并对相关的文章进行总结分析。结果：静脉血栓栓塞的预防和治疗对自发性脑出血患者的预后十分重要。预防血栓的措施主要分为物理预防和药物预防。本文综述了自发性脑出血后静脉血栓栓塞的药物预防措施以及治疗方案，特别是药物预防和抗凝治疗方面的研究现状。近期指南建议自发性脑出血患者进行早期机械预防，特别是间歇性肢体气动压缩。而关于药物预防和抗凝治疗的决策引起了临床医生的争论，因为抗凝药物的使用可能会增加脑再出血和血肿扩张的风险。关于最佳抗凝剂的选择、抗凝起始时间和药物使用剂量的不确定性仍然存在。结论：对于脑出血患者早期药物预防深静脉血栓的顾虑在被逐渐打消。我们需要一种更加准确、便捷、经济的识别血栓高危患者的工具。除了传统的实验室检查（如D-二聚体），多项指标联合预测也在越来越多的被证实。包括但不限于实验室指标的联合（如DFR）或风险工具联合实验室指标（如Wells评分联合DFR）。同时，人工智能和大数据的兴起也为临床医生提供了一条有别于传统医学的新路线。

脑出血；静脉血栓栓塞；肺栓塞；深静脉血栓形成；抗凝

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