妇科手术后静脉血栓栓塞症临床分析

目的:探讨妇科手术后静脉血栓栓塞症(VTE)的发生情况、危险因素及改良Caprini模型的运用。方法:选择四川大学华西第二医院2017年12月至2018年12月期间收治的妇科手术后发生VTE的35例患者为血栓组,另按照1∶4比例选择同期因相同疾病手术未发生VTE的140例患者为对照组。根据改良Caprini风险评估模型(不包括实验室检查结果,如V因子、凝血酶原20110A、血清同型半胱胺酸、狼疮抗凝物等)进行评分,对术后发生VTE的相关因素进行多因素Logistic回归分析。结果:①妇科手术患者共13211例,术后VTE发生率为0.26%(35/13211)。②血栓组改良Caprini平均得分高于对照组(5.20±1.83分vs 4.27±1.82分,P=0.011),血栓组改良Caprini评分≥5分的比例高于对照组(62.86%vs 44.29%,P=0.049)。③单因素分析发现妇科手术后发生VTE与年龄、BMI、手术时间及住院天数有关;多因素Logistic回归分析提示BMI≥24 kg/m^2(OR2.862,95%CI 1.277~6.417)、手术时间(OR 1.004,95%CI 1.001~1.008)是妇科术后VTE发生的独立危险因素(P<0.05)。④采用低分子肝素皮下注射抗凝治疗,同时对血栓所在的下肢制动,35例患者在观察期间均未继发出血。结论:VTE是妇科手术后严重的并发症,术后VTE发生的危险因素包括BMI(≥24 kg/m^2)、手术时间。根据改良Caprini风险度分级采取适当的预防措施,减少临床VTE的发生。

Clinical Analysis of Venous Thromboembolism after Gynecological Operation

Objective:To investigate the occurrence,risk factors of venous thromboembolism(VTE)and the application of modified Caprini model after gynecological operation.Methods:A total of 35 patients with VTE after gynecological operation in West China Second University Hospital,Sichuan University from December 2017 to December 2018 were selected as the thrombus group,and 140 patients without VTE during the same period due to the same disease were selected as the control group according to a ratio of 1∶4.The modified Caprini risk assessment model(excluding the results of laboratory tests,such as V factor,prothrombin 20110 A,serum homocysteine,lupus anticoagulants,etc.)was used for scoring,and multivariate Logistic regression was performed for the related factors of postoperative VTE.Results:①The incidence of postoperative VTE was 0.26%among13211 patients undergoing gynecological operation.②The average of modified Caprini score in the thrombus group was higher than that in the control group(5.20±1.83 vs.4.27±1.82,P=0.011).The ratio of modified caprini score≥5 in the thrombus group was higher than that in the control group(62.86%vs.44.29%,P=0.049).③Univariate analysis showed that the occurrence of VTE after gynecological operation was related to age,BMI,operation time and hospital stay.Multivariate Logistic regression analysis suggested that BMI≥24 kg/m^2(OR 2.862,95%CI 1.277-6.417)and operation time(OR 1.004,95%CI 1.001-1.008)was independent risk factors for VTE after gynecological operation(P<0.05).④Hypodermic injection of low molecular weight heparin(LMWH)was used for anticoagulation therapy,and the lower extremity where the thrombus was located was immobilized.None of the 35 patients had secondary bleeding during the observation period.Conclusions:VTE is a serious complication after gynecological operation.Risk factors for VTE after operation include BMI(≥24 kg/m^2)and operation time.According to the modified Caprini risk classification,appropriate preventive measures should be taken to reduce the occurrence of VTE in clinic.