妇科手术患者静脉血栓栓塞症的危险因素评估和评分简表的有效性验证

目的:探讨妇科手术患者静脉血栓栓塞症(VTE)危险因素及制定VTE危险因素评分简表,并对评分简表进行有效性验证。方法:收集2015年10月至2017年10月在西安交通大学第一附属医院妇科接诊并手术治疗后并发VTE的妇科肿瘤患者53例,对照组选择时间上相邻的2个妇科手术非VTE妇科肿瘤患者共106例。对年龄、体质量指数(BMI)、肿瘤性质、血栓相关病史、合并症、手术方式、手术时间、出血量、术后卧床时间、妊娠或产褥期、激素服用史进行单因素分析和多因素分析,并制定VTE危险因素的评分简表,应用该评分简表和Caprini评分表对所有患者进行评分比较。结果:单因素分析中,两组在BMI、肿瘤性质、手术时长、出血量、有无输血、卧床时间、血栓相关病史等方面差异有统计学意义(P<0.05)。多因素Logistic回归结果,年龄>60岁、BMI>28kg/m^2、恶性肿瘤、手术时长≥3小时、腹腔镜手术、血栓相关病史是影响妇科手术患者并发VTE的独立危险因素(P<0.05)。评分简表与Caprini评分表评分情况比较,两者差异无统计学意义(P>0.05)。结论:年龄大、BMI高、恶性肿瘤、手术时间长、腹腔镜手术及有血栓相关病史患者妇科手术后更易发生VTE。评分简表简便易操作且对于VTE识别度高,有一定临床实用价值。

Evaluation of Risk Factors for Venous Thromboembolism in Gynecologic Surgery Patients and Validation of a Simple Assessment Form

Objective:To retrospectively analyze the risk factors of venous thromboembolism in gynecological patients and verify the validity of a simple evaluation table.Methods:53 patients with VTE after gynecological consultation and surgical treatment at the First Affiliated Hospital of Xi'an Jiaotong University from October 2015 to October 2017 were enrolled.106 patients underwent two adjacent gynecologic operations were selected in the control group.Their age,body mass index(BMI),Tumor type,hietory of thrombosis,complication,surgical method,operation time,blood loss,bed rest time and other factors were obtained.A risk factor score table was established according to gynecology department and then all patients were marked by the score table.Results:In single-factor analysis,the two groups has statistically significant differences in BMI,tumor type,operation time,blood loss,blood transfusion,bed rest time and History of thrombosis(P<0.05).In multiple factor analysis,Age>60 years old,BMI>28 kg/m^2,malignant tumor,operation time≥3 hours,laparoscopic surgery,history of thrombosis are independent risk factors for VTE in patients underwent gynecologic surgery(P<0.05).Both the simple score table and the Caprini score table can identify 90%of the patients,and the difference is not statistically significant(P>0.05).Conclusions:Patients with older age,high BMI,malignant tumors,long-time surgery,laparoscopic surgery,or history of thrombosis may be more prone to VTE after gynecologic surgery.The simple assessment form is easy to operate and has a high recognition level for VTE.It can be applied widely.