Венозные тромбоэмболические осложнения в хирургии сколиоза: обзор литературы

Цель исследования. Представить современные научные сведения по проблеме венозных тромбоэмболических осложнений у детей и подростков в хирургии сколиоза.
Материал и методы. Поиск научных источников осуществляли в базах данных PubМed, GoogleScholar, eLibrary за период 2012–2024 гг. Проанализировали содержание 57 журнальных статей, освещающих вопросы частоты, этиологии, факторов риска развития венозных тромбоэмболических осложнений и тромбопрофилактики в педиатрической когорте в целом и в когорте детей и подростков, оперированных по поводу сколиоза.
Результаты. Частота развития венозных тромбоэмболических осложнений при хирургической коррекции сколиоза незначительна и составляет не более 1,0 %. Этиология венозных тромбоэмболических осложнений является многофакторной, имеет место как генетическая предрасположенность, так и приобретенные факторы риска. Для детей и подростков наиболее важными являются возраст, семейный или личный тромботический анамнез, область операции, продолжительность хирургического вмешательства более 120 мин, повторные и сложные операции, кровопотеря, анемия, инфекции, иммобилизация более 48 ч, длительное пребывание в стационаре, наличие хронических заболеваний или сопутствующего нарушения системы гемостаза в виде гиперкоагуляции. В подростковом возрасте особую значимость приобретают курение, использование оральных контрацептивов и ожирение. Признано, что наличие четырех из указанных факторов требует относить пациента к группе с высоким риском развития венозных тромбозов и эмболических осложнений.
Заключение. С учетом низкой частоты венозных тромбоэмболических осложнений в хирургии сколиоза, потенциальных рисков использования антикоагулянтных препаратов, а также эффективного послеоперационного сопровождения пациентов путем ранней активизации и использования внешних компрессионных устройств проведение медикаментозной профилактики в хирургии сколиоза не рекомендуется. Вместе с тем отсутствие регламентирующих документов по скринингу и профилактике венозных тромбоэмболических осложнений для этой категории пациентов сопряжено с трудностями выявления тех клинических случаев, когда медикаментозная профилактика абсолютно показана.

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