不同血栓风险评估工具在产科住院患者中的应用效果研究

目的比较Caprini血栓风险评估量表与上海孕产妇静脉血栓危险因素评分表在产科住院患者静脉血栓栓塞症发生中的预测价值。方法本研究为病例对照研究。选择山东第一医科大学附属省立医院2010年1月至2021年9月收治出院时确诊并发静脉血栓栓塞症产妇67例, 并选取同期未发生静脉血栓栓塞症的产妇144例, 采用Caprini血栓风险评估量表与上海孕产妇静脉血栓危险因素评分表对产妇进行评估, 比较2种评估工具的预测有效性及准确性。结果 2种静脉血栓发生风险评估工具在产前、产后评价效果均不同, 差异均有统计学意义(Z=8.15、5.97, 均P<0.01), 在产前、产后预测准确性方面上海孕产妇静脉血栓危险因素评分表分别为83.9%、67.3%, 均优于Caprini血栓风险评估量表的52.1%、45.0%;ROC曲线下面积显示, 产后上海孕产妇静脉血栓危险因素评分表为0.863, 高于Caprini血栓风险评估量表的0.748。结论上海孕产妇静脉血栓危险因素评分表较Caprini血栓风险评估量表在孕产妇静脉血栓栓塞症早期风险识别中价值更高。     

基于Caprini风险评估模型预防下肢静脉曲张患者围术期静脉血栓栓塞症的临床研究

目的观察基于Caprini风险评估模型预防下肢静脉曲张手术患者围术期静脉血栓栓塞症的效果。方法将680例下肢静脉曲张手术患者按照随机数字表法分为对照组340例和观察组340例。对照组给予常规预防方法,观察组在此基础上使用Caprini风险评估模型评估患者静脉血栓栓塞症发生的风险,并根据风险程度采取相应的预防措施。结果观察组未发生静脉血栓栓塞症,对照组发生深静脉血栓形成5例(其中1例发生无症状肺动脉栓塞),两组比较,差异无统计学意义(P0.05)。观察组患者皮下淤血、皮肤硬结、患肢疼痛情况高于对照组,差异有统计学意义(P0.05)。两组患者下肢肿胀情况比较,差异无统计学意义(P0.05)。结论 Caprini风险评估模型应用于下肢静脉曲张手术患者,可降低术后静脉血栓栓塞症的发生,但增加了皮下淤血、皮肤硬结、患肢疼痛等并发症的发生。     

神经外科手术患者并发静脉血栓栓塞症的相关危险因素分析

目的 探讨神经外科手术患者发生静脉血栓栓塞症的危险因素,为患者静脉血栓栓塞症的管理提供参考。方法 通过回顾性分析210例神经外科行择期手术患者的资料,将其分为静脉血栓栓塞症组(105例)和非静脉血栓栓塞症组(105例),采用单因素分析和二元logistic回归分析神经外科手术患者发生静脉血栓栓塞症的影响因素。结果 二元logistic回归分析结果显示,住院时间(OR=1.047)、心血管疾病史(OR=18.100)、Caprini评分(OR=2.981)、使用镇静镇痛药物(OR=5.021)、术后日常生活活动能力评分(OR=0.961)、术后D-二聚体(OR=1.313)进入回归方程,差异有统计学意义(P<0.05)。结论 住院时间长、有心血管疾病史、Caprini评分高、使用镇静镇痛药物及术后D-二聚体高是神经外科手术患者发生静脉血栓栓塞症的危险因素,术后日常生活活动能力评分高是患者发生静脉血栓栓塞症的保护因素,建议构建敏感性更高的神经外科静脉血栓栓塞症风险评估模型,以利于医护人员早期识别神经外科静脉血栓栓塞症高风险人群并及时采取预防措施。     

基于Caprini模型评价胸腔镜下肺叶切除术后肺癌患者静脉血栓栓塞症发生风险

目的探讨基于Caprini模型评价胸腔镜下肺叶切除术后患者发生静脉血栓栓塞症(VTE)的风险,并分析VTE发生的相关危险因素。方法选取2016年1月—2018年1月在山东省胸科医院进行胸腔镜下肺叶切除术治疗的42例早期肺癌患者作为对照组,另选取同期在同家医院行手术且术后并发VTE的28例早期肺癌患者作为观察组。收集、对比两组患者的一般资料和Caprini风险评估得分,分析Caprini风险评估模型中的危险因素。结果观察组的年龄、术前纤维蛋白原、术前D-二聚体均高于对照组,观察组的恶性肿瘤史、BMI≥25 kg/m2、高血压、高血糖、方式为叶切、有吸烟史的比例均高于对照组,差异均有统计学意义(P<0.05)。观察组Caprini风险评估得分高于对照组,差异有统计学意义(P<0.01)。多因素分析结果显示,肺癌患者胸腔镜下肺叶切除术后VTE的危险因素为血浆D-二聚体高于临界值、有吸烟史、BMI≥25 kg/m2(P<0.05)。结论Caprini风险模型能有效预测胸腔镜肺叶切除术后患者发生VTE,可分类量化DVT发病风险。术前血浆D-二聚体升高、体重超重、重度吸烟史可能是胸腔镜肺叶术后患者发生VTE的高危因素。     

两种血栓风险评估模型在住院患者深静脉血栓形成中的预测价值研究

目的比较Caprini血栓风险评估模型及Autar血栓风险评估量表对住院患者深静脉血栓(deep vein thrombosis,DVT)形成的预测价值。方法采用回顾性病例对照研究的方法,便利抽样法选取院内2013年1月至2016年12月住院患者中确诊为DVT的269例患者为病例组,随机269例非DVT患者为对照组。收集两组患者的临床资料,分别采用Caprini风险评估模型及Autar血栓风险评估量表对其血栓发生风险进行评估,探讨风险分层及相关危险因素与DVT发生风险之间的关系。结果两种风险评估模型对病例组患者的DVT风险评估平均得分均高于对照组(P0.01),但针对高危患者的筛选,Caprini风险评估模型诊出的高风险率显著高于Autar血栓风险评估量表(P0.01);比较ROC曲线下面积发现,Caprini风险评估模型曲线下面积大于Autar血栓风险评估量表(P0.01);此外,Caprini风险评估模型风险分层结果显示,随着风险分层的增高,患者DVT的发生风险也在逐级递增,两者呈正相关关系(P0.05);进一步对Caprini风险评估模型中的危险因素进行Logistic回归分析探讨危险因素与DVT发生风险的相关性,共计8个危险因素是DVT发生的高危因素(P0.05)。结论 Caprini风险评估模型对住院患者DVT发生风险的预测较Autar血栓风险评估量表更有效,根据DVT风险分层结果对患者实施针对性护理预防,为院内血栓防治提供了有力保障,可在临床推广使用。     

全髋关节置换后深静脉血栓栓塞与APACHEⅡ评分:98例资料回顾

背景:全髋关节置换后发生深静脉血栓栓塞的发生存在多种危险因素,且涉及多个临床学科,目前尚缺乏系统、可靠的评分预测系统.但临床上早期可以通过深静脉多普勒超声来判断其发生情况.急性生理学与慢性健康评定标准(APACHE Ⅱ)在国内外已被广泛用于对ICU危重患者病情严重程度的分析和预后评估.目的:评价APACHE Ⅱ评分与全髋关节置换后深静脉血栓栓塞的相关性.方法:回顾性分析2000/2005解放军401医院全髋关节置换病例98例(106髋)的动态APACHE Ⅱ评分,包括置换前、发生深静脉血栓时及出现肺栓塞时,比较深静脉血栓栓塞症发生组与未发生组的APACHE Ⅱ评分差异,以及深静脉血栓栓塞症患者中发生肺栓塞组与未发生肺栓塞组的APACHE Ⅱ评分差异.结果与结论:发生深静脉血栓栓塞症组与未发生深静脉血栓栓塞症组置换前APACHE Ⅱ评分差异无显著性意义(P>0.05).深静脉血栓栓塞症患者中肺栓塞组APACHE Ⅱ评分明显高于未发生肺栓塞组(P<0.05).提示APACHE Ⅱ评分与早期深静脉血栓栓塞症的发生无明显相关性;但深静脉血栓栓塞症发生后,APACHE Ⅱ评分与肺栓塞发生有相关性,且APACHE Ⅱ评分分值越高,肺栓塞发生风险越大.     

住院精神疾病患者并发VTE危险因素分析及预测模型构建

目的 分析精神疾病住院患者并发静脉血栓栓塞症的危险因素,构建风险预测模型。方法采用单因素分析及Logistic回归分析探究患者并发静脉血栓栓塞症的影响因素,建立精神疾病患者并发静脉血栓栓塞症的模型,采用Hosmer-Lemeshow检验评估模型的拟合度,绘制受试者工作特征曲线检测模型的预测效能。结果 有下肢深静脉血栓史和下肢水肿史、营养风险≥3分、持续卧床时间≥48h、联合使用抗精神病药物、日饮水量<1 500ml均为影响精神疾病患者并发静脉血栓栓塞症的独立危险因素（P<0.05）。精神疾病患者并发静脉血栓栓塞症的风险预测模型,Hosmer-Lemeshow检验的χ2=4.53(P>0.05),模型预测静脉血栓栓塞的曲线下面积为0.858,95%CI为0.797～0.920。结论 多种因素影响精神疾病患者并发静脉血栓栓塞症,风险预测模型能够很好的预测其静脉血栓栓塞的发生,为临床医护人员早期识别、及时展开针对性的干预措施提供了参考依据。     

四种血栓评估表对肾病综合征患者血栓形成的预测价值比较

目的比较Padua量表、修正的Geneva量表、Caprini量表和Wells量表对肾病综合症患者静脉血栓栓塞(VTE)风险的预测价值。方法采用回顾病例分析的方法,收集2018年1月—2020年4月确诊VTE的肾病综合征患者45例。资料收集完成后由专人采用四种评估量表对患者进行VTE评分,统计得出不同评估量表的评分结果。结果肾病综合征合并肺栓塞中,Padua评分和Caprini评分ROC曲线下面积低于修正Geneva评分和Wells评分。肾病综合征合并深静脉栓塞中,修正Geneva评分和Wells评分ROC曲线下面积低于Padua评分和Caprini评分。结论四种血栓评估量表评分均能预测肾病综合征患者VTE发生的风险,Wells评分则更能预测肾病综合征患者发生肺栓塞的风险,Padua评分更能评估肾病综合征患者形成深静脉血栓的风险,但Caprini静脉血栓评分项更能针对肾病综合征。     

Caprini血栓风险评估在电视胸腔镜肺癌根治术病人中的应用

目的:观察Caprini血栓风险评估模型用于预测电视胸腔镜(VATS)肺癌根治术后静脉血栓栓塞(VTE)的价值,以指导临床合理预防VTE发生.方法:选择2018年1月—2020年1月医院行VATS肺癌根治术的204例肺癌病人作为研究对象,于术后采用Caprini及Padua血栓风险评估模型评估病人VTE风险,并记录病人VTE发生情况,分析Caprini及Padua血栓风险评估模型对VATS肺癌根治术后VTE发生的预测价值.结果:204例VATS肺癌根治术病人的VTE发生率为10.78％;VTE病人Caprini及Padua血栓风险评分均高于无VTE病人(P<0.05);组间其他基线资料比较差异无统计学意义(P>0.05);经单项Logistic回归分析后建立Logistic多元回归模型行多因素分析,结果显示,VATS肺癌根治术病人病程、Caprini及Padua血栓风险评分是VATS肺癌根治术后病人VTE发生的影响因素(P<0.05);绘制受试者工作曲线(ROC)发现,术后6 h时Caprini血栓风险评分预测VATS肺癌根治术后VTE发生风险的曲线下面积(AUC)>0.90,有高预测性能,Padua血栓风险评分预测术后VTE发生风险的AUC>0.80,有一定预测性能.结论:Caprini血栓风险评分与VATS肺癌根治术后VTE的发生有定性关系,预测VTE的价值较Padua血栓风险评估模型高,可根据评分结果进一步制定针对性VTE预防措施,可能对改善VATS肺癌根治术病人预后有积极意义.     

Caprini血栓风险评估模型联合分级护理干预对胸腔镜肺癌切除术后患者静脉血栓形成的影响

目的:探究Caprini血栓风险评估模型联合分级护理干预对胸腔镜肺癌切除术后患者静脉血栓形成的影响。方法:选取2019年1月至2021年8月新疆医科大学第一附属医院收治的136例胸腔镜肺癌切除术后患者为研究对象,按随机数字表法随机分为对照组与观察组,每组68例。对照组予以常规护理,观察组在常规护理基础上先根据Caprini风险评估模型对静脉血栓形成风险进行分级,再依风险等级予以分级护理。比较两组静脉血栓栓塞症(venous thromboembolism,VTE)发生情况、术后恢复情况、护理满意度及手术前后D-二聚体、血小板计数(platelet count,PLT)水平。结果:观察组VTE总发生率明显低于对照组(P<0.05);观察组血栓最大宽度明显小于对照组(P<0.05)。与对照组相比,观察组胸管留置时间、住院时间均明显更短,日常生活能力(activities of daily living,ADL)评分则明显更高,组间比较差异均有统计学意义(均P<0.05)。观察组术后3d时D-二聚体、PLT水平均明显低于对照组(均P<0.05)。观察组健康教育与指导、个人特质及服务态度、服务质量、出院指导评分均明显高于对照组(均P<0.05)。结论:Caprini血栓风险评估模型联合分级护理干预可有效预防胸腔镜肺癌切除术后患者VTE的发生,降低术后D-二聚体、PLT水平,促进术后恢复,并可提高患者对护理的满意度。     

Caprini风险评估在预防关节置换术后患者深静脉血栓中的应用效果

目的 探讨基于Caprini风险评估的护理干预对预防关节置换术后深静脉血栓(deep venous thrombosis, DVT)的效果。 方法 选取我科2016年6月-2017年6月行膝关节置换术的患者100例,采用随机数字表法将其分为对照组与观察组,各50例。对照组予以常规护理,观察组实施基于Caprini风险评估的护理。比较2组患者患肢疼痛、肿胀程度、DVT发生情况。 结果 观察组未发生DVT,对照组出现3例肌间静脉血栓。2组术后的疼痛、肿胀程度在组间、时间和交互效应上均有统计学差异(P＜0.05)。 结论 运用Caprini量表进行风险评估,并依据风险程度合理实施护理,可有效降低关节置换术后并发症的发生率。     

中老年患者院内发生静脉血栓栓塞症风险预测模型的研究

目的 了解中老年患者院内发生静脉血栓栓塞症的危险因素,并在此基础上构建风险预测模型。方法 选择2015年1月—2018年12月在某三级甲等综合性医院所有住院期间发生静脉血栓栓塞症（venous thromboembolism,VTE）的55例中老年患者纳入VTE组,按照1：2的比例选择同年度入住同一科室、同一主要诊断、年龄相近、性别相同且住院期间没有发生VTE的患者108例纳入非VTE组,对两组的一般资料、Caprini血栓风险评估模型分值、合并疾病、相关实验室检查指标、可能的危险因素、用药情况等进行病例回顾研究,筛选出危险因素并利用Logistic回归进行风险预测模型的构建,并选择2013年1月—2014年12月同一医院住院期间发生VTE和非VTE患者共54例对模型进行验证。结果 Logistic回归分析显示,呼吸道感染/呼吸衰竭、肝肾疾病、饮酒史、D-二聚体浓度和Caprini血栓风险等级是中老年患者发生VTE的危险因素。结论 本研究构建的VTE风险预测模型可以对中老年患者院内发生VTE起到一定的辅助预测作用,该模型尚需由多中心大样本试验进一步验证和完善。     

The venous stasis syndrome after deep venous thrombosis or pulmonary embolism: a population-based study

OBJECTIVES: To estimate the incidence and determine predictors of venous stasis syndrome and venous ulcers after deep venous thrombosis and pulmonary embolism. PATIENTS AND METHODS: This population-based retrospective cohort study reviewed medical records of 1527 patients with incident deep venous thrombosis or pulmonary embolism between 1966 and 1990. We recorded baseline characteristics, event type (deep venous thrombosis with or without pulmonary embolism or pulmonary embolism alone), leg side and site of deep venous thrombosis (proximal with or without distal deep venous thrombosis vs distal deep venous thrombosis alone), and venous stasis syndrome and venous ulcer. RESULTS: Two hundred forty-five patients developed venous stasis syndrome. One-year, 5-year, 10-year, and 20-year cumulative incidence rates were 7.3%, 14.3%, 19.7%, and 26.8%, respectively. By 20 years the cumulative incidence of venous ulcers was 3.7%. Patients with deep venous thrombosis with or without pulmonary embolism were 2.4-fold (95% confidence interval, 1.7-fold-3.2-fold) more likely to develop venous stasis syndrome than patients with pulmonary embolism and no diagnosed deep venous thrombosis. In patients aged 40 years or younger with proximal compared with distal-only deep venous thrombosis, venous stasis syndrome was 3.0-fold more likely (95% confidence interval, 1.6-fold-4.7-fold). In patients with unilateral leg deep venous thrombosis, venous stasis syndrome usually developed in the concordant leg (P < .001). There was a 30% (95% confidence interval, 2%-62%) increased risk for venous ulcer per decade of age at the incident venous thromboembolism. CONCLUSIONS: The cumulative incidence of venous stasis syndrome continues to increase for 20 years after venous thromboembolism. Pulmonary embolism alone is less likely to cause venous stasis syndrome.     

Anticoagulation in elective surgery.

Several categories of patients may be receiving anticoagulation therapy and require surgery. Many patients take cardioprotective aspirin or warfarin for atrial fibrillation, the presence of a mechanical heart valve, prior thromboembolism, a documented left ventricular thrombus, or a history of venous thromboembolism with or without a pulmonary embolism. Inpatients may be receiving injectable forms of anticoagulation to reduce risk of deep venous thrombosis or for other conditions, such as atrial fibrillation. Patients receiving any type of anticoagulation present a problem when they require surgery because the interruption of anticoagulant therapy increases their risk of thromboembolism and stroke (Schanbacher & Bennett, 2000). Rational decisions regarding the appropriateness of perioperative anticoagulation depend on individual patient factors and can only be made when the risk of perioperative thromboembolism is balanced against the risk of perioperative bleeding.     

DVT and pulmonary embolism: Part II. Treatment and prevention

Treatment goals for deep venous thrombosis include stopping clot propagation and preventing the recurrence of thrombus, the occurrence of pulmonary embolism, and the development of pulmonary hypertension, which can be a complication of multiple recurrent pulmonary emboli. About 30 percent of patients with deep venous thrombosis or pulmonary embolism have a thrombophilia. An extensive evaluation is suggested in patients younger than 50 years with an idiopathic episode of deep venous thrombosis, patients with recurrent thrombosis, and patients with a family history of thromboembolism. Infusion of unfractionated heparin followed by oral administration of warfarin remains the mainstay of treatment for deep venous thrombosis. Subcutaneously administered low-molecular-weight (LMW) heparin is at least as effective as unfractionated heparin given in a continuous infusion. LMW heparin is the agent of choice for treating deep venous thrombosis in pregnant women and patients with cancer. Based on validated protocols, warfarin can be started at a dosage of 5 or 10 mg per day. The intensity and duration of warfarin therapy depends on the individual patient, but treatment of at least three months usually is required. Some patients with thrombophilias require lifetime anticoagulation. Treatment for pulmonary embolism is similar to that for deep venous thrombosis. Because of the risk of hypoxemia and hemodynamic instability, in-hospital management is advised. Unfractionated heparin commonly is used, although LMW heparin is safe and effective. Thrombolysis is used in patients with massive pulmonary embolism. Subcutaneous heparin, LMW heparin, and warfarin have been approved for use in surgical prophylaxis. Elastic compression stockings are useful in patients at lowest risk for thromboembolism. Intermittent pneumatic leg compression is a useful adjunct to anticoagulation and an alternative when anticoagulation is contraindicated.     

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。     

Venous thromboembolism after trauma

PURPOSE OF REVIEW: The trauma population is at increased risk of venous thromboembolic disease, a potentially preventable cause of mortality and morbidity. Although the association between trauma and venous thromboembolism has been recognized for more than a century, there is still great variability in the clinical practices with respect to prophylaxis. This thorough review of recent literature aims to clarify the incidence and risk factors for deep venous thrombosis and pulmonary embolism after trauma, review options and recommendations for detection of deep venous thrombosis and pulmonary embolism, and give evidence-based recommendations for prophylaxis. Special attention is paid to patients with spinal cord injury, patients with head injury, and pediatric trauma patients. RECENT FINDINGS: Highlights in this field during the past year include stratification of venous thromboembolism risk factors after trauma using a large national database, the expanded use of venous duplex ultrasound surveillance in the ICU and during rehabilitation, and investigations into the safety of low molecular weight heparins in patients with solid organ and traumatic brain injuries. Additionally, two new classes of anticoagulant drugs have been introduced for venous thromboembolism prophylaxis, and there are some preliminary studies on a temporary vena cava filter for the prevention of pulmonary embolism. SUMMARY: Venous thromboembolism remains an area of active clinical research focusing on evolving diagnostic techniques, newer methods of chemical and mechanical prophylaxis, and improved understanding of the etiologic factors of posttraumatic venous thromboembolism. These efforts will undoubtedly decrease the posttraumatic morbidity and mortality associated with venous thromboembolism.     

肺癌合并静脉血栓栓塞症的临床特征及预后影响因素分析

目的:探讨肺癌合并静脉血栓栓塞症(venous thromboembolism,VTE)的临床特征、治疗模式、转归及影响因素.方法:选择2015年1月1日至2020年12月31日大连医科大学附属第一医院收治的肺癌患者5769例,筛选新发VTE患者,收集性别、年龄、吸烟史、临床分期、病理类型等临床资料,分析肺癌合并VTE...     

肺血栓栓塞症相关因素分析与护理探讨

目的探讨肺血栓塞症(PTE)危险因素和预见性的护理措施。方法对住院治疗的61例PTE患者的资料进行相关的统计学处理。结果PTE的危险因素有:骨折、创伤、手术、恶性肿瘤、围产期、长期卧床及老年心脑血管病,尤其是既往有深静脉血栓形成和静脉曲张者。结论对高危人群进行全面评估制定详细护理的护理计划,加强早期监护,采取预见性护理措施,是减少PTE发生、降低死亡和促进康复的关键。