北京某大型综合医院术后静脉血栓栓塞症发生的危险因素分析

目的 探索北京某大型综合医院术后静脉血栓栓塞症(VTE)发生的危险因素，为临床预防和管理术后VTE提供参考依据。方法 检索病案首页数据，查询2012 - 2017年在北京某三甲医院进行外科手术治疗的患者，以出院诊断包含深静脉血栓形成(DVT)或肺血栓栓塞症(PE)的患者作为病例组，对照组采用1∶2匹配方法选择出院诊断无DVT或PE的患者，应用条件logistic回归分析术后VTE发生的危险因素。结果 （1）纳入试验组患者373例，对照组患者710例。高龄、麻醉时间长、术后卧床时间长是术后VTE的独立危险因素（P＜0.05）。（2）术前住院日长、术前采用血栓风险评估、术后采用物理抗凝措施是降低术后VTE风险的因素（P＜0.05）。（3）术后卧床时间对不同性别患者的术后VTE的发生风险影响不同；体腔开放性手术的术后卧床时间对术后VTE发生的OR值为1.24（95%CI:1.12～1.38），高于腔镜手术（1.14，95%CI:1.09～1.19）。结论 高龄、麻醉时间长、术后卧床时间长的患者发生术后VTE的风险较高，而术前进行血栓风险评估、术后采取物理抗凝措施可以降低术后VTE的发生风险。

Analysis of the risk factors of postoperative venous thromboembolism in large general hospital in Beijing

Objective The aim of this study was to explore the risk factors of postoperative venous thromboembolism (VTE) in a large general hospital in Beijing in order to provide reference for clinical prevention and management of postoperative VTE. Methods Patients with postoperative DVT or PE diagnosed in the Third Hospital of Peking University from 2012 to 2017 were enquired by searching the data on the front page of medical records. 1:2 matched case-control method was applied to select patients without postoperative DVT or PE as the control group. Conditional logistic regression analysis was used to analyze the risk factors of postoperative VTE. Results (1) 373 patients were included in the case group and 710 in the control group. Older age, longer anesthesia time and longer bedridden time after operation were independent risk factors for postoperative VTE (P<0.05). (2) Preoperative hospitalization day, preoperative thrombosis assessment and physical anticoagulation measures after operation reduced the risk of postoperative VTE(P<0.05). (3) The risk of postoperative VTE varied among gender. The OR of VTE after laparotomy was 1.24(95% CI: 1.12-1.38), which was higher than that of endoscopic surgery (1.14, 95% CI: 1.09-1.19). Conclusion The risk of postoperative VTE was higher in elderly patients, longer anesthesia time and longer bedridden time after operation. Preoperative VTE assessment and physical anticoagulation measures after operation can reduce the risk of postoperative VTE.