杨立颖,吴海涛

重症创伤性脑损伤（TBI）患者因长期卧床、凝血功能紊乱及血管内皮损伤等因素，深静脉血栓（DVT）形成风险显著升高，而DVT的发生可能加重病情甚至导致致命性肺栓塞。低分子肝素（LMWH）作为临床常用的抗凝药物，在预防DVT方面已广泛应用，但在重症TBI患者中，其使用时机、剂量及安全性仍存在争议。本文综述了低分子肝素干预重症TBI患者DVT的作用机制、临床研究进展、应用争议及优化策略，旨在为临床决策提供参考。

低分子肝素；重症创伤性脑损伤；深静脉血栓；抗凝治疗；风险评估

[1] Mona H,Tetsu O,Ruba S,et al.Early Vasopressor Utilization in Critically Ill Patients With Acute Traumatic Spinal Cord Injury:A Retrospective Cohort Study[J].Critical Care Medicine,2025, [2] Pryzmont M,Kosciuczuk U,Maciejczyk M.Biomarkers of traumatic brain injury:narrative review and future prospects in neurointensive care[J].Frontiers in Medicine,2025,12 1539159-1539159. [3] Patterson S,Brigg N,Handy M,et al.A reason to recover:A qualitative study of recovery after traumatic chest wall injury requiring intensive care admission.[J].Injury,2025,56(5):112330. [4] M.R,Kshirasagar D C,Amrita R,et al.Efficacy of prophylactic enteral bromocriptine in reducing the neurogenic fever in severe traumatic brain injury patients in the trauma intensive care unit-A randomized placebo-controlled study[J].International Journal of Critical Illness and Injury Science,2025,15(2):90-95. [5] Yuan D,Jin Y,Chen L,et al.Neurological outcomes and predictive factors in traumatic spinal cord injury patients in the intensive care unit.[J].PloS one,2025,20(5):e0323433. [6] Alaifan T,Sakhakhni A,Khojah A,et al.Impact of Dexmedetomidine on Hospital and Intensive Care Unit Stay Duration in Adult Traumatic Brain Injury Patients:A Systematic Review.[J].Drug,healthcare and patient safety,2025,17 157-171. [7] Wang Y W,Holland C I,Fong T C,et al.Personalizing Prediction of High Opioid Use in the Neurointensive Care Unit:Development and Validation of a Stratified Risk Model for Acute Brain Injury Due to Stroke or Traumatic Brain Injury[J].Journal of Clinical Medicine, 2024,13(23):7055-7055. [8] Garside T,Stanford R,Flower O,et al.Blood pressure management in acute spinal cord injury:A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres.[J].Australian critical care:official journal of the Confederation of Australian Critical Care Nurses,2024,38(2):101131. [9] Mathew K S,Aruna S,Vasudevan C R,et al.Integrating Family Involvement in Neuro-Intensive Care:A Pathway to Enhanced Family Satisfaction in Traumatic Brain Injury(TBI)Management.[J].Cureus,2024,16(11):e74748. [10] 周自新,张加齐,饶枭,等.创伤性脑损伤后血管痉挛研究进展[J].西南医科大学学报,2025,48(04):391-397. [11] 王秉贤,谢胜强,何仁可,等.基于多时间点蛋白组学分析海水浸泡合并创伤性脑损伤后小鼠脑组织分子病理机制的动态演变[J].中华神经外科疾病研究杂志,2025,19(03):44-51. [12] 赵锦程,王星,李起超,等.血清水通道蛋白4和Tau蛋白对重型创伤性脑损伤去骨瓣术后脑积水的预测价值[J].中华神经外科疾病研究杂志,2025,19(03):69-74. [13] 杨洋,陈力,徐永君,等.神经调节蛋白-1:创伤性脑损伤合并海水浸泡的细胞焦亡调控新靶点?[J].中华神经外科疾病研究杂志, 2025,19(03):174-177. [14] 赵吉倩,杨丁丁,王嘉铭,等.线粒体在创伤性脑损伤中的作用机制研究进展[J/OL].空军军医大学学报,1-17[2025-07-27]. [15] 洪新杰,徐涛,侯立军.纳米酶在创伤性颅脑损伤治疗中的应用进展[J].创伤外科杂志,2025,27(06):472-475. [16] 陈星星,陈正薰,张蝶,等.钾通道Kv1.3介导创伤性脑损伤后神经功能障碍及神经炎症[J].中国药理学与毒理学杂志, 2025,39(06):401-411. [17] 杨英豪,梁径山,刘长涛,等.急性创伤性脑损伤后进展性出血性损伤患者神经功能预后模型的构建[J].浙江医学,2025, 47(11):1189-1194. [18] 杨欣娴,张中美,张雪艳,等.萝卜硫素在创伤性脑损伤中作用及机制研究进展[J].中华实用诊断与治疗杂志,2025,39(06):573-576. [19] 来杭佳.创伤性脑损伤继发癫痫的危险因素分析[J].中外医药研究,2025,4(16):52-54. [20] Bhide M,Juneja D,Singh O,et al.Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit.[J].World journal of critical care medicine,2024,13(3):97205. [21] Lotsios N,Vrettou C,Poupouzas G,et al.Glucocorticoid receptor response and glucocorticoid-induced leucine zipper expression in neutrophils of critically ill patients with traumatic and non-traumatic brain injury[J].Frontiers in Endocrinology,2024,15 1414785-1414785. [22] Bouchard R D,Harris M,Getchell J,et al.Outcomes of Traumatic Brain Injury Patients Managed in a Non-Intensive Care Unit Setting.[J].The Journal of surgical research,2024,302 679-684. [23] Rask F,Uvelius E,Marklund N.Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study[J].Brain and Spine,2024,4 102821-. [24] Chen W,Wu H,Yu J,et al.Epidemiological characteristics of traumatic spinal cord injuries in the intensive care unit from 2018 to 2023:a retrospective hospital-based study.[J].World journal of emergency medicine,2024,15(6):455-464. [25] Plooy D E,Salie S,Figaji A A.A profile of children with traumatic brain injury admitted to the paediatric intensive care unit of Red Cross War Memorial Children's Hospital in Cape Town,South Africa,between 2015 and 2019.[J].The Southern African journal of critical care:the official journal of the Critical Care Society,2024,40(3):e2212. [26] Mar S,Julie A F,A V M,et al.Physicians'beliefs and perceived importance of traumatic brain injury-associated agitation in critically ill patients:a survey of Canadian intensivists.[J].Canadian journal of anaesthesia=Journal canadien d'anesthesie,2023,71(2):264-273. [27] Shubhayu B,Erta B,Patrick Z,et al.The Therapy Intensity Level scale for traumatic brain injury:clinimetric assessment on neuro-monitored patients across 52 European intensive care units.[J].Journal of neurotrauma,2023, [28] Teodor W S,Anders H,Per E,et al.Intracranial lesion features in moderate-to-severe traumatic brain injury:relation to neurointensive care variables and clinical outcome.[J].Acta neurochirurgica,2023,165(9):2389-2398. [29] Matias L,Juho V,Stepani B,et al.Incidence and risk factors of posttraumatic hydrocephalus and its association with outcome following intensive care unit treatment for traumatic brain injury:a multicenter observational study.[J].Journal of neurosurgery,2023,139(5):11-10. [30] Krassimir D,Jonathan G,Pinxia C,et al.Traumatic Brain Injury:Intraoperative Management and Intensive Care Unit Multimodality Monitoring[J].Anesthesiology Clinics,2023,41(1):39-78.

点击下载PDF