Padua量表在内科住院患者静脉血栓栓塞症中的应用研究进展

静脉血栓栓塞症(VTE)在内科住院患者中的发生率逐年升高,内科住院患者疾病复杂、病情严重、合并静脉血栓风险因素较多,是发生VTE的高危人群.VTE是可防可控性疾病,早发现早治疗能够显著降低改善患者预后,提高患者生活质量.Padua量表是目前国内外指南推荐用于内科住院患者VTE筛查的最优模型,现就Padua量表在国内外内...     

Padua评分在国内静脉血栓栓塞症风险评估中的研究进展

综述Padua评分在国内临床科室静脉血栓栓塞症风险预测价值及应用现状,以期为临床医护人员应用Padua评分提供参考依据.     

Caprini和Pauda风险评估模型联合使用对筛选内科住院患者静脉血栓栓塞症的应用价值

目的验证Caprini和Padua风险评估模型联合使用在内科住院患者中筛选静脉血栓栓塞症（VTE）的有效性。 方法采用单中心回顾性研究,分析从2017年8~12月青岛大学附属医院内科住院患者资料,以Caprini和Padua风险评估模型对所有患者进行回顾性血栓风险评分,并通过Logistic二分类回归分析得到Caprini和Padua联合使用后的预测概率模型,分别绘制3种模型的受试者工作特征曲线（ROC）,采用Delong法比较3种模型的曲线下面积,以Youden指数最大的分界点作为最佳诊断分界点。 结果Caprini和Padua联合使用后的预测概率模型ROC曲线下面积高于Caprini模型和Padua模型（0.927±0.009 vs 0.739±0.020,0.927±0.009 vs 0.817±0.017）,差异具有统计学意义（Z=10.659,Z=8.952,P均<0.001）。并且预测概率模型灵敏度及特异度均大于Caprini或Padua（83.7% vs 79.1% vs 72.1%;87.9% vs 66.7% vs 82.7%）。 结论Caprini和Padua风险评估模型联合使用可提高筛选内科住院患者VTE的准确性。     

住院患者静脉血栓栓塞症的风险评估:护理的价值

静脉血栓栓塞症(VTE)是住院患者常见的并发症之一,住院患者可能存在VTE高危因素。护理作为VTE防治的重要组成部分,护士应准确识别危险因素、及时正确进行VTE风险评估,采取恰当的预防措施对预防VTE意义重大。     

内科住院患者静脉血栓栓塞症的预防

现已明确,对有静脉血栓栓塞症（VTE）高危风险的内科住院患者给予血栓预防措施可明确降低VTE的发病率和病死率。2009年我国颁布了＂内科住院患者静脉血栓栓塞症预防的中国专家建议＂〔1〕。2012年美国胸科医师学会颁布了血栓形成抗栓治疗和预防第9版指南〔2〕,此文对该指南中有关内科住院患者VTE预防的建议进行解读。     

儿童静脉血栓栓塞症风险评估模型的研究进展

综述国内外儿童静脉血栓栓塞症发生现状及风险评估模型研制现状,以期为我国儿童静脉血栓栓塞症风险评估模型的研制提供借鉴,为改善儿童静脉血栓栓塞症的预防管理提供参考。     

风险评估模型在神经外科静脉血栓栓塞症防护中的应用研究

目的探究使用风险评估模型在神经外科静脉血栓栓塞症(VTE)防护中的应用价值。方法选取我院2017年8月～2018年8月收治2610例神经外科患者,患者均接受风险评估模型来评估VTE风险等级,神经外科VTE发生率以及Caprini评分,VTE与非VTE患者VTE风险分级比较。结果所有入选患者出现VTE患者16例(0.61%),未出现VTE发生2594例(99.39%),分别纳入VTE组与非VTE组,两组Caprini评分分别为8.64±0.34分和5.64±0.12分,两组比较差异有统计学意义(P0.05);VTE组与非VTE组患者VTE风险分级分布情况比较差异均无统计学统计学意义(P0.05),两组中高危以及极高危风险患者均占比较高。结论神经外科患者存在高危VTE发生风险,风险评估模型用于预测神经外科VTE发生风险应用价值较高,可有效降低VTE发生率。     

创伤患者静脉血栓栓塞症风险评估工具的研究进展

<正>静脉血栓栓塞症(venous thromboembolism,VTE)包括深静脉血栓(deep vein thrombosis,DVT)及肺栓塞(pulmonary embolism,PE)^[1],是创伤后的主要并发症之一。VTE可导致患者住院日延长、住院费用增加、死亡率上升^[2],积极的VTE预防对于创伤患者而言至关重要。     

产褥期静脉血栓栓塞症发生风险评估及预防效果分析

目的 分析产褥期静脉血栓栓塞症发生风险评估及预防效果。方法 选取我院产后血栓风险评估高危产妇80例,分为两组各40例。对照组给予常规产后护理指导,试验组给予静脉血栓栓塞症发生风险评估及预防干预,比较两组产妇产褥期静脉血栓栓塞症发生情况。结果 试验组产妇产褥期静脉血栓栓塞症发生率为0.00%,对照组为10.00%,试验组低于对照组,P<0.05。结论产褥期产妇存在静脉血栓栓塞症发生风险,进行科学风险评估和有效预防可降低病症发生率,保护产妇安全,值得推荐。     

内科住院患者静脉血栓栓塞症风险评估工具的预测价值比较

目的比较Padua评分表及中国专家推荐的简版评估方案(以下简称简评法)对内科住院患者静脉血栓栓塞(VTE)风险评估的预测效能, 以期为临床选择合适的风险评估工具提供参考。方法采用回顾性队列研究方法。便利抽样法选取北京大学深圳医院2021年5月1日至2022年4月30日出院的42 257例内科住院患者为研究对象。收集患者入院时的一般资料、VTE相关资料、住院期间患者VTE发生情况及2种评估工具的评估结果等, 通过绘制ROC曲线、计算AUC、灵敏度、特异度、阳性预测值、阴性预测值及预测准确性, 评价工具的预测效能。结果 42 257例患者中男21 065例, 女21 192例, 年龄(55.04 ± 15.17)岁。内科患者在住院期间VTE发生率为2.24%(948/42 257)。Padua评分表和简评法在评估所有内科住院患者时的AUC分别为0.735(95%CI 0.717～0.753)和0.582(95%CI 0.561～0.602), 灵敏度分别为49.4%和18.2%, 特异度分别为89.6%和98.1%, 阳性预测值分别为9.9%和17.7%, 阴性预测值分别为98.7%和98...     

对住院内科患者开展人性化护理服务的调查

目的详细了解内科患者在住院期间对人性化护理服务的需求,探讨人性化护理的服务措施。方法采用自行设计的调查问卷对60名内科住院患者进行调查,调查内容包括环境和护理服务两方面。结果内科患者在环境和健康教育方面的需求强烈,同时在护理服务的细节、护士的仪表和语言上也提出了合理的建议。结论为进一步提高护理服务质量,应从营造一个良好的住院环境和提供优质、全面的护理服务人手,注重患者的心理需求和人格尊严,真正体现人性化的服务理念。     

Palliative Sedation in Patients Hospitalized in Internal Medicine Departments

ContextPalliative sedation is used to relieve end-of-life refractory symptoms.ObjectiveThe objective of this study was to describe the use of palliative sedation in patients who die in internal medicine departments.MethodsAn observational, cross-sectional, retrospective, and multicenter clinical audit study was conducted in 145 hospitals in Spain and Argentina. Each hospital included the first 10 patients who died in the internal medicine department, starting on December 1, 2015.ResultsWe included 1447 patients, and palliative sedation was administered to 701 patients (48.4%). Having a terminal illness (odds ratio [OR] 2.469, 95% CI 1.971–3.093, P < 0.001) and the length of hospital stay (OR 1.011, 95% CI 1.002–1.021, P = 0.017) were independently associated with the use of palliative sedation. Consent was granted by the families of 582 (83%) patients. The most common refractory symptom was dyspnea, and the most commonly used drugs for sedation were midazolam (77%) and morphine (89.7%). An induction dose was administered in 25.7% of the patients. Rescue doses were scheduled for 70% of the patients, and hydration was maintained in 49.5%. Pain was more common in patients with cancer, whereas dyspnea was more common in those without cancer. Rescue doses were used more often for the patients with cancer (77.8% vs. 67.7%, P = 0.015). Monitoring the palliative sedation with a scale was more frequent in the patients with cancer (23.7% vs. 14.3%, P = 0.008).ConclusionsPalliative sedation is used more often for terminal patients. There are differences in the administration of palliative sedation between patients with and without cancer.     

普外科住院患者营养风险筛查

目的运用营养风险筛查2002工具对普外科患者进行营养风险状况和营养支持现状调查。方法对2011年3月-8月在普外科新入院的520例患者进行营养风险筛查,判定是否存在营养风险,同时用已纳入患者现有的临床营养支持状况,分析目前临床营养支持的合理性。结果 476例(91.5%)患者完成筛查。有营养风险者156例(32.8%),无营养风险者320例(67.2%)。在有营养风险患者中,实施临床营养支持者有131例,占84.0%;无营养风险患者中,实施了营养支持者占40.3%。结论基层县级医院普外科入院患者营养风险发生率较高,并且临床营养支持合理性尚待改善。     

心血管内科住院病人失眠相关因素分析及对策

失眠 (insomnia)是睡眠障碍中最常见的一种 ,失眠包括入睡困难、清晨觉醒过早、睡眠时间短、睡眠中断、白昼睡眠过多[1] 。失眠对心血管病人是一种应激 ,资料报道应激可增加儿茶酚胺(特别是肾上腺素 )的分泌 ,导致血管收缩、血压上升、呼吸加快、新陈代谢增加 ,提高血浆游离脂肪酸和三酰甘油的水平 ,增大血小板的粘性。有人观察到在应激中可引起心律失常 ,如出现阵发性心动过速 ,房性或室性早搏等[2 ] ,具有失眠症而随后患急性心梗的病人非常普遍[3 ] 。在临床护理中我们发现 ,病人常常被失眠困扰 ,故采用问卷调查方法 ,了解 80例住院心血管…     

Autar量表与Caprini评估模型对肿瘤患者PICC相关静脉血栓形成预测效果的对比研究

目的 比较Autar量表与Caprini评估模型对肿瘤患者PICC相关静脉血栓形成的预测效度。方法 采用病例对照研究,收集2012—2017年125例行PICC置管肿瘤患者的一般资料、置管资料。将确诊已发生PICC相关静脉血栓的肿瘤患者作为病例组,按照肿瘤类型相同采用1∶4配对方法,选取同期留置但未发生PICC相关静脉血栓的患者作为对照组,使用Autar量表与Caprini评估模型分别对患者进行评分并记录,并分析2个量表的最佳诊断界值。结果 Caprini评估模型最佳诊断界值为7分,灵敏度为0.661,特异度为0.724,曲线下面积为0.763;Autar量表最佳诊断界值为10分,灵敏度为0.642,特异度为0.555,曲线下面积为0.632。结论 Caprini评估模型灵敏度与特异度均高于Autar量表,能够更好地预测肿瘤患者发生PICC相关静脉血栓的风险。     

Clinical and Cancer-Related Predictors for Venous Thromboembolism in Cancer Patients Presenting to the Emergency Department

BackgroundThe accurate detection of cancer-associated venous thromboembolism (VTE) can avoid unnecessary diagnostic imaging or laboratory tests.ObjectiveWe sought to determine clinical and cancer-related risk factors of VTE that can be used as predictors for oncology patients presenting to the emergency department (ED) with suspected VTE.MethodsWe retrospectively analyzed all consecutive patients who presented with suspicion of VTE to The University of Texas MD Anderson Cancer Center ED between January 1, 2009, and January 1, 2013. Logistic regression models were used to identify risk factors that were associated with VTE. The ability of these factors to predict VTE was externally validated using a second cohort of patients who presented to King Hussein Cancer Center ED between January 1, 2009, and January 1, 2016.ResultsCancer-related covariates associated with the occurrence of VTE were high-risk cancer type (odds ratio [OR] 3.64 [95% confidence interval {CI} 2.37–5.60], p < 0.001), presentation within 6 months of the cancer diagnosis (OR 1.92 [95% CI 1.62–2.28], p < 0.001), active cancer (OR 1.35 [95% CI 1.10–1.65], p = 0.003), advanced stage (OR 1.40 [95% CI 1.01–1.94], p = 0.044), and the presence of brain metastasis (OR 1.73 [95% CI 1.32–2.27], p < 0.001). When combined, these factors along with other clinical factors showed high prediction performance for VTE in the external validation cohort.ConclusionsCancer risk group, presentation within 6 months of cancer diagnosis, active and advanced cancer, and the presence of brain metastases along with other related clinical factors can be used to predict VTE in patients with cancer presenting to the ED.     

孕产妇孕产期静脉血栓栓塞风险评估的最佳证据总结

目的 获取国内外孕产妇孕产期相关静脉血栓风险评估的最佳证据,为构建评估工具提供参考依据.方法 应用循证医学的方法,通过计算机检索Up To Data、BMJ、Cochrane Library、JBI、GIN、NCG、NICE、CMA、RNAO、PubMed、Embase、中国知网、万方数据库、中国生物医学数据库,选取符...     

风险管理在呼吸内科护理管理中的应用

目的：探讨风险管理在呼吸内科护理管理中的应用效果。方法2013年1－12月,在湖北省武汉市东西湖人民医院呼吸内科实施风险管理,将风险识别、护理风险分析、强化护理风险管理等措施贯穿于护理管理的始终,评价并比较实施风险管理前后的护理质量和护理不良事件的发生率。结果实施风险管理后,呼吸内科的基础护理质量、病房管理及危重患者护理质量评分均高于实施前（均 P ＜0．05）,不良事件的发生率均低于实施前（均 P ＜0．05）,差异均有统计学意义。结论将风险管理应用于呼吸内科的护理管理中,可提高呼吸内科护理服务质量,降低护理风险。     

Code Status Discussions: Agreement Between Internal Medicine Residents and Hospitalized Patients

Background: Medical residents frequently participate in code status discussions, yet their competency in this role has not been evaluated. Purpose: The objective is to determine the quality of code status discussions from the perspective of both resident and patient. Methods: We conducted a cross-sectional survey of consecutive pairs of hospitalized patients and admitting residents at Mayo Clinic in March 2007. We measured perceptions of occurrence and content of code status discussions, admission volume, and demographic information. Results: Among the 41 matched pairs, residents and patients agreed that a code status conversation occurred in 63% of cases. Agreement was more likely if residents performed less than 4 admissions ( p= .02). Patients reported the inclusion of specific discussion components, such as resuscitation procedures (7%) and outcomes (0%), less frequently than residents (71% and 27%, respectively, p< .001). Conclusions: Residents and patients demonstrated poor agreement on the occurrence and components of code status conversations. Residency programs should identify ways to enhance residents’ competency in eliciting patients’ code status preferences and provide adequate time for code status discussions.     

Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism

ObjectiveTo compare the clinical efficacy and safety of apixaban with those of rivaroxaban for the treatment of acute venous thromboembolism (VTE).Patients and MethodsConsecutive patients enrolled in the Mayo Thrombophilia Clinic Registry (between March 1, 2013, and January 30, 2018) and treated with apixaban or rivaroxaban for acute VTE were followed forward in time. The primary efficacy outcome was VTE recurrence. The primary safety outcome was major bleeding; the second safety outcome was clinically relevant nonmajor bleeding (CRNMB); and the third was a composite of major bleeding or CRNMB.ResultsWithin the group of 1696 patients with VTE enrolled, 600 (38%) were treated either with apixaban (n=302, 50%) or rivaroxaban (n=298, 50%) within the first 14 days of VTE diagnosis and who completed at least 3 months of therapy or had a study event. Recurrent VTE was diagnosed in 7 patients (2.3%) treated with apixaban and in 6 (2%) treated with rivaroxaban (adjusted hazard ratio [aHR], 1.4; 95% CI, 0.5-3.8). Major bleeding occurred in 11 patients (3.6%) receiving apixaban and in 9 patients (3.0%) receiving rivaroxaban (aHR, 1.2; 95% CI, 0.5-3.2). Clinically relevant nonmajor bleeding was diagnosed in 7 patients (2.3%) receiving apixaban and in 20 (6.7%) receiving rivaroxaban (aHR, 0.4; 95% CI, 0.2-0.9). The rates of composite major bleeding or CRNMB were similar (aHR, 0.6; 95% CI, 0.3-1.2). Most study events occurred in patients with cancer.ConclusionIn the setting of a standardized, guideline-directed, patient-oriented clinical practice, the efficacy and safety of apixaban and rivaroxaban for the treatment of acute VTE were comparable.