99例晚期恶性肿瘤患者静脉血栓栓塞症的诊治情况分析

目的:了解晚期恶性肿瘤患者合并静脉血栓栓塞症（venous thromboembolism，VTE)的诊治及预防情况，加强肿瘤相关性VTE的认知，提高患者生活质量及改善预后。方法:收集2012年1月至2016年10月住院确诊为VTE的肿瘤患者（VTE组）的病历资料，与同时期入院的非VTE的肿瘤患者对照（对照组），对两组资料进行Logistic回归分析，寻找可能的VTE高危因素。结果:VTE组及对照组各99例患者。VTE组中，年龄>60岁64例，ZPS评分>2分57例，IV期65例；以彩超确诊者84例，以CT诊断者15例；发生在下肢深静脉者71例。VTE组:49例应用低分子肝素抗凝，出院后应用华法林后续治疗10例，大多数VTE组患者未应用预防性抗凝。在多因素Logistic回归分析中，血红蛋白下降、凝血酶时间延长以及中心静脉置管的应用在统计学上存在显著的差异。结论:恶性肿瘤合并VTE多发生在60岁以上、IV期和活动不良的患者，其后续抗凝治疗不足，临床上缺乏主动预防的措施及意识。

Analysis of diagnosis and treatment of venous thromboembolism in 99 cases of patients with advanced malignant tumor

Objective:To understand the treatment and prevention of patients with advanced malignant tumor combined with venous thromboembolism (VTE)，to strengthen the cognition，improve the life quality and prognosis.Methods:From January 2012 to October 2016，the general situation of the VTE group and the control group were acquired.Logistic regression analysis was performed on the data of the two groups for possible VTE risk factors.Results:99 patients for the two groups respectively were acquired.In the VTE group，64 cases was over 60 years old，57 patients whose ZPS scores were over 2，and 65 cases were in stage IV.There were 84 cases with color ultrasonography and 15 patients with CT diagnosis.There were 71 cases in the lower extremity deep vein.In the VTE group，49 patients were treated with low molecular heparin anticoagulation，10 patients were treated with warfarin after discharge.The majority of VTE group patients did not use preventive anticoagulation after diagnosis of tumor.In multivariate Logistic regression analysis，there was a statistically significant difference in the decline of hemoglobin，the extension of thrombin time，and the application of central venous catheter.Conclusion:Malignant tumors with VTE occur in patients over 60 years age，stage IV and poor activity，the follow-up treatment was insufficient.We lacks active preventive measures and awareness.