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。     

原发性肺癌静脉血栓栓塞症影响因素分析

目的肺癌患者症状性静脉血栓栓塞症(venous thromboembolism,VTE)发病率较高,将加重患者病情。本研究旨在分析原发性肺癌患者发生VTE的影响因素。方法选择2016-01-01-2018-01-01灌南县第一人民医院收治的114例原发性肺癌患者为研究对象,其中肺癌并发VTE 37例为病例组,无VTE 77例为对照组。依据检查结果由专业人员统计患者的病理类型与肿瘤分期情况,收集患者的人口学信息、体质量指数(body mass index,BMI)、并发病史、肿瘤坏死因子、血红蛋白、D-二聚体、血黏稠度、血小板、白细胞、白细胞介素1、谷丙转氨酶及谷草转氨酶等数据信息,利用Logistic回归分析进一步探讨肺癌患者发生VTE的影响因素。结果病例组与对照组的病理类型和肿瘤分期比较,差异有统计学意义,均P<0.05。单因素分析发现,吸烟史、BMI、肿瘤坏死因子、血红蛋白、D-二聚体,血黏稠度、白细胞及白细胞介素1等指标,两组比较差异均有统计学意义,均P<0.05。多因素Logistic回归分析结果显示,肿瘤分期(OR=2.177,95%CI为1.462～3.241,P=0.001)、D-二聚体(OR=5.890,95%CI为2.379～14.581,P=0.005)、白细胞介素1(OR=1.362,95%CI为1.193～1.556,P=0.007)、肿瘤坏死因子(OR=1.380,95%CI为1.028～1.852,P=0.014)为肺癌VTE的影响因素。结论原发性肺癌患者发生VTE受多种因素的共同影响,其中肿瘤分期、D-二聚体、白细胞介素1、肿瘤坏死因子是并发VTE的危险因素。     

妇科疾病常见引发静脉血栓栓塞症的高危因素

静脉血栓栓塞症( venous thromboembolism, VTE)是指各种病因导致血液在静脉系统异常凝集的一组疾病,包括深静脉血栓形成( deep venous thrombosis, DVT)和肺栓塞( pulmonary embolism, PE) ,是仅次于心肌梗死和卒中的全球第三大心脑血管急症[1].约...     

骨科下肢创伤患者围手术期静脉血栓栓塞的影响因素分析研究

目的:分析评估骨科下肢创伤患者围术期静脉血栓栓塞的影响因素.方法:2019年1月至2020年12月为本研究年限范围,样本为我院收治300例骨科下肢创伤患者,全部患者均行手术治疗,其中240例患者未发生围术期静脉血栓栓塞,将其作为对照组,60例患者发生围术期静脉血栓栓塞,将其作为研究组,统计分析两组患者临床资料,探究相关...     

颅脑肿瘤术后并发静脉血栓栓塞症危险因素的Meta分析

目的明确颅脑肿瘤术后患者发生静脉血栓栓塞症(VTE)的危险因素。方法检索中国知网、万方、维普、中国生物医学文献、PubMed、The Cochrane Library、Web of Science、EMbase等数据库建库至2021年11月1日颅脑肿瘤术VTE危险因素的队列研究或病例对照研究。由两名研究人员独立进行文献筛选、资料提取以及文献质量评价。使用RevMan 5.4软件对纳入文献进行Meta分析。结果共纳入14篇文献,合计样本量40 552例,发生VTE1 801例。Meta分析结果显示,年龄＞45岁、术前D-二聚体升高、肥胖、女性、术前日常生活活动能力处于依赖状态、术前呼吸机依赖、术前曾患脓毒血症、高级神经胶质瘤、手术时间＞3.05 h、术后D-二聚体升高、术后下肢运动功能障碍、术后卧床不起、术后并发尿路感染为颅脑肿瘤术后患者发生VTE的危险因素。结论颅脑肿瘤术后VTE发生与多种因素有关。建议构建颅脑肿瘤术后VTE风险预测模型,关注高风险人群,落实规范化静脉血栓风险评估,注重血栓评估过程管控。     

下肢肿痛警惕静脉血栓栓塞

我们把外周静脉血栓和肺动脉栓塞统称为静脉血栓栓塞症。事实上,所有的静脉系统都可以发生血栓,最常见的部位在下肢。当血栓发生了移动,可以通过心脏进入到肺动脉循环系统,也就是肺动脉栓塞,大概有80％以上的肺动脉栓塞就是来自于下肢静脉。当然其它部位也可以发生血栓,比如盆腔静脉、上肢静脉、下腔静脉、上腔静脉、颈静脉以及颈静脉窦区等。     

妇科术后并发下肢静脉血栓形成的影响因素及防治

下肢静脉血栓（deep vein thrombosis,DVT）是指血液在深静脉内不正常地凝结、阻塞管腔,导致的静脉回流障碍［1］。临床表现为低热,患肢肿痛,皮温增高,浅表静脉扩张等,甚至可因栓子脱落而致肺栓塞（ pulmonary embol-ism,PE）死亡。有资料统计,妇科腹部手术后并发下肢深静脉血栓形成的发生率高达7％-45％［2］。早期预防,早期发现,早期治疗,对避免医疗纠分也具有重要的现实意义［3］。因此,对 DVT 进行有效的预防措施,对降低妇科术后下肢深静脉血栓的发生具有重要的意义。现综述如下。     

静脉血栓栓塞症发生情况调查及对策探讨

目的探讨建立一套切实可行、有效的院内静脉血栓栓塞症管理模式。方法回顾性分析2013年-2014年住院患者静脉血栓栓塞症发生病例及风险评估和预防措施落实情况,查找存在问题,针对问题提出整改措施。结果建立了院内静脉血栓栓塞症管理方案。结论改进后的方案可筛选出高危患者,可进行有效预防。     

基于临床资料构建预测模型对淋巴瘤化疗患者发生静脉血栓栓塞症的预测价值

目的 探讨基于临床资料构建预测模型在淋巴瘤化疗患者发生静脉血栓栓塞症(VTE)中的应用价值,为临床降低淋巴瘤化疗患者发生VTE提供防治措施。方法 回顾性分析2016年1月至2023年5月于苏州大学附属苏州九院进行化疗治疗的177例淋巴瘤患者的临床资料,依据患者完成化疗1个疗程(7～14 d)后评估有无发生VTE分为VTE组(51例)和非VTE组(126例)。对两组患者的临床资料进行单因素分析,并采用多因素Logistic回归分析模型筛选出淋巴瘤化疗患者发生VTE的影响因素,并构建淋巴瘤化疗患者发生VTE的预测模型。采用受试者工作特征(ROC)曲线评估模型的效能,采用Hosmer-Lemeshow检验评估模型的拟合情况。结果 VTE组患者年龄、化疗前血小板计数(PLT)、化疗前D-二聚体水平高于非VTE组,Ann Arbor分期Ⅳ的患者占比均高于非VTE组(均P<0.05);多因素Logistic回归分析结果显示,年龄高、Ann Arbor分期高、PLT水平高、D-二聚体水平高均是淋巴瘤化疗患者发生VTE的影响因素(均P<0.05),由此得到Logistic回归模型公式：Z=...     

探究妇产科术后静脉血栓栓塞症的防治措施

目的 分析探讨妇产科术后静脉血栓栓塞症的诊断与治疗措施.方法 回顾性分析笔者所在医院46例妇产科术后下肢深静脉血栓栓塞症患者的临床资料,探讨其正确诊断及早期治疗方法.结果 46例患者经常规治疗、抗凝和溶栓药物治疗后下肢疼痛、轻度肿胀均消失,患肢活动自如,住院8~14 d,出院后随访2个月,未发现遗留症.结论 正确诊断静脉血栓栓塞症（VTE）,根据患者的病情早期给予积极抗凝溶栓治疗,可消除临床症状,同时防止深静脉血栓（DVT）发展为严重的肺栓塞（PTE）,降低发病率、病死率.     

Range of published estimates of venous thromboembolism incidence in young women

OBJECTIVE: This review was conducted to show the full range of incidence estimates published for venous thromboembolism (VTE) in women depending on study design and to suggest a more reliable estimate for women of reproductive age. METHODS: A literature search was performed to identify studies on the incidence of VTE in women. Incidence rates were compiled from studies with different methodologies and varying methodological quality. Algorithms were used to estimate VTE incidence from more reliable studies in young women. RESULTS AND DISCUSSION: The literature shows two levels of VTE incidence rates: community/cohort studies and database studies. The estimated VTE incidence for women of reproductive age was 5.5-13.5 and 3.8-12.2 in community and cohort studies, respectively, but only 0.7-3.8 per 10,000 women-years (WY) in database studies. This difference is probably attributable to methodological problems associated with some database studies. CONCLUSION: The VTE incidence in women of reproductive age is likely to be in the range of 5-10 per 10,000 WY. These rates for the background incidence are clearly higher than the reference figures that are often utilized in the comparison with users of hormonal contraception (0.5-1 VTE per 10,000 WY).     

Cost-effectiveness of fondaparinux vs. enoxaparin as venous thromboembolism prophylaxis in Sweden

Deep-vein thrombosis and pulmonary embolism are important causes of morbidity and mortality among patients undergoing major surgery. Fondaparinux is a new antithrombotic agent for use in prophylaxis, and this study compared its cost and effect vs. enoxaparin as prophylactic treatment in patients undergoing total knee replacement, total hip replacement, or hip-fracture surgery in Sweden. The analyses were based on a simulation model. Swedish data on cost for deep-vein thrombosis and pulmonary embolism were obtained from a large sample of patients undergoing major orthopedic surgery. The relative risk reduction for treatment with fondaparinux was estimated from results of four recently published clinical trials. The base case analyses showed that fondaparinux was cost saving and more effective than enoxaparin after total knee replacement and hip-fracture surgery and had costs per prevented venous thromboembolism of about €239 after total hip replacement. Fondaparinux is thus more cost-effective than enoxaparin as prophylactic treatment in patients undergoing major surgery in Sweden.     

Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery

A model was developed to estimate costs and clinical effectiveness of fondaparinux compared with enoxaparin after hip fracture surgery in Sweden. Outcomes and costs of venous thromboembolism (VTE)-related care from a health care perspective were incorporated, with symptomatic deep-vein thrombosis and pulmonary embolism, recurrent VTE, post-thrombotic syndrome, major haemorrhage and all-cause death being included. Event probabilities were derived from fondaparinux clinical trial data and published data. VTE-related resource use and associated costs as well as costs of prophylaxis were based on local Swedish data. Extended prophylaxis with fondaparinux could avoid an additional 28 symptomatic VTE per 1,000 patients compared with extended prophylaxis with enoxaparin in hip fracture surgery patients. Although the prophylaxis costs were higher in the fondaparinux group, these were offset by the lower costs associated with treating fewer VTE, which thus indicates that extended fondaparinux prophylaxis is the dominant alternative when compared with enoxaparin in hip fracture surgery.      

急性肺栓塞患者深静脉血栓形成的 危险因素分析

目的 分析急性肺血栓栓塞(PTE)患者深静脉血栓形成(DVT)的临床危险因素.方法 资料来源于2002年6月至2004年12月入选肺栓塞溶栓与抗凝治疗多中心随机对照研究的454例患者.全部患者均经CT肺动脉造影和/或核素肺通气灌注扫描或磁共振肺动脉造影或直接肺动脉造影明确诊断为急性PTE.比较PTE有DVT与PTE无DVT的两组患者,筛选出PTE中DVT的危险因素.结果 对有DVT和无DVT患者,进行性别、年龄、BMI及基础疾病包括高血压、冠心病、慢性阻塞性肺疾病、糖尿病、脑卒中和肿瘤等比较,除糖尿病外(χ2=4.481,P=0.034),其余各指标在两组间的差异均无统计学意义.DVT的体征包括下肢水肿、静脉炎和双下肢周径差≥1 cm在两组间的差异均具有统计学意义(P＜0.01).通过logistic回归确定下肢水肿(OR=2.255;95%CI:1.493～3.408)、静脉炎(OR=2.380;95%CI:1.426～3.973)和双下肢周径差≥1 cm(OR=3.834;95%CI:2.561～5.738)是DVT的独立判断因素.结论 下肢水肿、静脉炎和双下肢周径差≥1 cm是DVT的危险因素.在临床工作中应注意检查DVT的体征,尤其应注意测量双下肢周径.     

剖宫产术后下肢深静脉血栓形成的危险因素分析

目的:探讨剖宫产手术后下肢深静脉血栓(LEDVT)发生的危险因素。方法:选取2008年1月～2012年1月在唐山市妇幼保健院、工人医院及协和医院行剖宫产术共20 998例患者,术前完善相关化验,术后2～7天行双下肢静脉彩超检查,除LEDVT患者外,在整个人群中随机选取LEDVT 2倍人群作为对照组,对影响LEDVT的因素进行单因素和多因素Logistic回归分析。结果 :①符合术后LEDVT诊断标准者共716例,发生率为3.41%。②计量资料中,病例组的体重指数、部分凝血酶原活化时间、纤维蛋白原、D二聚体、抗凝血酶-Ⅲ、C反应蛋白均高于对照组;计数资料中,病例组的高血压病史、糖尿病病史、吸烟史、血栓史、口服避孕药史的LEDVT患病率均高于对照组。③单因素Logistic回归分析显示,年龄、体重指数、部分凝血酶原活化时间、D二聚体、抗凝血酶-Ⅲ、C反应蛋白、高血压病史、糖尿病病史、吸烟史、血栓史、口服避孕药史、缺乏体育锻炼等均为深静脉血栓形成的独立危险因素;多因素Logistic回归分析显示,年龄、体重指数、D二聚体、抗凝血酶-Ⅲ、C反应蛋白是深静脉血栓形成的独立危险因素。结论 :剖宫产术后LEDVT的发生率较高;LEDVT的发生与年龄、体重指数、D二聚体、抗凝血酶-Ⅲ、C反应蛋白有关。建议对有LEDVT高危因素的患者术后2～7天常规筛查下肢深静脉血栓,加强术后护理及治疗,以减少LEDVT并发症发生。     

术后静脉血栓栓塞症

目的了解术后静脉血栓栓塞患者的特点,为临床预防和治疗提供参考。方法选取1997年1月-2004年8月诊治的47例术后下肢深静脉血栓形成的患者,并对资料作一回顾性分析。结果关节、脊柱、创伤手术是引起术后静脉血栓栓塞的高危因素;术后下肢深静脉血栓形成的发生有两个高峰:术后3 d内和10 d后;肺栓塞占静脉血栓栓塞患者的27．7％,均见于中央型和/或混合型下肢深静脉血栓形成患者。单纯抗凝治疗下肢深静脉血栓痊愈10例(21．3％),显效 18例(38．3％),有效19例(40．4％);肺栓塞者痊愈5例(38．5％),显效4例(30．8％),有效4例 (30．7％)。下肢深静脉血栓复发者5例,肺栓塞复发者2例,瓣膜功能未恢复者3例。结论 (1) 静脉血栓栓塞症高危患者需行手术和发生创伤时,应采取措施预防静脉血栓栓塞症。(2)注意术后迟发性下肢深静脉血栓形成。(3)两种影像学辅助检查相互配合可提高静脉血栓栓塞症的诊断。     

Oral contraceptives and venous thromboembolism: a five-year national case-control study

The objective of this study was to assess the influence of oral contraceptives (OCs) on the risk of venous thromboembolism (VTE) in young women. A 5-year case-control study including all Danish hospitals was conducted. All women 15-44 years old, suffering a first ever deep venous thrombosis or a first pulmonary embolism (PE) during the period January 1, 1994, to December 30, 1998, were included. Controls were selected annually, 600 per year in 1994-1995 and 1200 per year 1996-1998. Response rates for cases and controls were 87.2% and 89.7%, respectively. After exclusion of nonvalid diagnoses, pregnant women, and women with previous thrombotic disease, 987 cases and 4054 controls were available for analysis. A multivariate, matched analysis was performed. Controls were matched to cases within 1-year age bands. Adjustment was made for confounding influence (if any) from the following variables: age, year, body mass index, length of OC use, family history of VTE, cerebral thrombosis or myocardial infarction, coagulopathies, diabetes, years of schooling, and previous birth.The risk of VTE among current users of OCs was primarily influenced by duration of use, with significantly decreasing odds ratios (OR) over time: <1 year, 7.0 (5.1-9.6); 1-5 years, 3.6 (2.7-4.8); and >5 years, 3.1 (2.5-3.8), all compared with nonusers of OCs. After adjustment for confounders, current use of OCs with second- (levonorgestrel or norgestimate) and third- (desogestrel or gestodene) generation progestins when compared with nonuse resulted in ORs for VTE of 2.9 (2.2-3.8) and 4.0 (3.2-4.9), respectively. After adjusting for progestin types and length of use, the risk decreased significantly with decreasing estrogen dose. With 30-40 microg as reference, 20 and 50 microg products implied ORs of 0.6 (0.4-0.9) and 1.6 (0.9-2.8), respectively (p(trend) = 0.02). After correction for duration of use and differences in estrogen dose, the third/second-generation risk ratio was 1.3 (1.0-1.8; p <0.05). In conclusion, use of OCs was associated significantly to the risk of VTE. The risk among current users was reduced by more than 50% during the first years of use. The risk increased more than 100% with increasing estrogen dose, and the difference in risk between users of third- and second-generation OCs, after correction for length of use and estrogen dose, was 33%.     

Patient ethnicity and use of venous thromboembolism prophylaxis.

OBJECTIVE: Patients at highest risk for developing venous thromboembolism include those undergoing major orthopedic surgery. However, physicians vary in their strategies to prevent venous thromboembolism. We evaluated whether the use of venous thromboembolism prophylaxis after orthopedic surgery is related to patient ethnicity. DESIGN: Retrospective cohort study, 1998-2002. SETTING: Tertiary care, university-affiliated hospital in Hawaii. STUDY PARTICIPANTS: 1811 adults (1085 women; 743 Asians; 206 Pacific Islanders; mean age 70.6 +/- 14.7 years) who underwent hip replacement, hip fracture surgery, or total knee replacement. MAIN OUTCOME MEASURES: Use of venous thromboembolism prophylaxis as recommended by the American College of Chest Physicians. Multivariable logistic regression was used to identify factors associated with prophylaxis use. RESULTS: Overall, 49.4% of patients received venous thromboembolism prophylaxis. After adjustment for patient age, sex, thromboembolism and bleeding risk factors, type of surgery, and anesthesia, Japanese patients were less likely to receive prophylaxis [odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5-0.9; P = 0.01], whereas other ethnic groups were treated similarly to whites. Relative to patients undergoing hip replacement, those with hip fracture surgery were less likely (OR = 0.4; 95% CI = 0.3-0.5; P < 0.01), and those receiving total knee replacement more likely (OR = 4.5; 95% CI = 3.6-5.7; P < 0.01) to receive appropriate prophylaxis. CONCLUSION: Despite consensus recommendations, venous thromboembolism prophylaxis use among high-risk patients remains low. Japanese patients and those undergoing hip fracture surgery are at particular risk for not receiving appropriate prophylaxis in our population. Further research is needed to clarify the reasons for our findings and to determine if this variation is associated with increased risk of thromboembolic complications.     

妊娠相关静脉血栓栓塞的危险因素及其预防决策

静脉血栓栓塞(VTE)是指静脉血管管腔内血液异常凝结,形成血栓而使血管完全或部分阻塞,引起血液循环障碍。VTE主要包括深静脉血栓形成(DVT)和肺栓塞,而颅内静脉窦血栓形成及卵巢静脉血栓形成等临床少见。VTE是一种非常严重,而且具有潜在致死性的妊娠并发症。孕产妇作为特殊人群,妊娠本身即为其发生VTE的危险因素,若同时合并其他可能导致VTE发生的危险因素,如孕前危险因素、产科危险因素及孕期新发或一过性危险因素等,均可导致妊娠期及产褥期妇女发生VTE的风险增高。临床如何识别VTE危险因素,并对这些高危因素进行相应管理,是产科临床亟待解决的难题。目前,我国孕产妇VTE死因构成比呈逐年上升趋势,但是迄今尚无孕产妇VTE管理的指南或专家共识。笔者拟主要参考现有的妊娠相关VTE的危险因素及其预防、诊治指南的研究证据,从妊娠期女性发生VTE的病因,妊娠期及产褥期孕产妇发生VTE的危险因素,妊娠相关VTE危险因素评估及妊娠相关VTE预防4个方面,阐述妊娠相关VTE危险因素、危险分级及其管理策略,旨在为我国妊娠相关VTE危险因素识别及规范管理,提供实用性临床指导。