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。

Risk assessment of venous thromboembolism based on Caprini model in lung cancer patients after thoracoscopic surgery

Objective To explore the risk assessment of venous thromboembolism(VTE)based on Caprini model in patients after thoracoscopic lobectomy and to analyze the related risk factors of VTE.Methods From January 2016 to January 2018,this study selected 42 early lung cancer patients with thoracoscopic lobectomy of Shandong Provincial Chest Hospital in control group,and selected 28 early lung cancer patients with VTE after surgery in observation group.This study also collected and compared the general information and the score of the Caprini risk assessment of patients between two groups,and analyzed the risk factors in the Caprini risk assessment model.Results The ages,preoperative fibrinogen,preoperative D-Dimer,the ratio of histories of malignant tumor,body mass index(BMI)≥25 kg/m2,hypertension,hyperglycemia,lobectomy and smoking history of observation group were higher than those of control group with statistical differences(P<0.05).The score of the Caprini risk assessment of observation group was higher than that of control group with statistical difference(P<0.01).Multivariate analysis showed that risk factors of VTE of lung cancer patients after thoracoscopic surgery included the D-Dimer higher than critical value,smoking history and BMI≥25 kg/m2 with statistical differences(P<0.05).Conclusions Caprini risk assessment model can effectively calculate the patients with VTE after thoracoscopic lobectomy,classify and quantize the incidence risk of deep vein thrombosis(DVT).The high risk factors of patients with VTE after thoracoscopic lobectomy include the increased D-Dimer,overweight and heavy smoking.