深静脉血栓危险因素的评估和预防

目的：通过评估深静脉血栓（deep venous thrombosis，Dvr）的危险等级，采取预防措施降低深静脉血栓发生率。方法：依据《美国深静脉血栓预防医嘱》，结合亚洲地区关于深静脉血栓的文献报道，制定出适合西宁地区（海拔2264m）深静脉血栓的危险因素评估表，根据此表评估住院手术患者。观察组对2011年7月22日-2013年6月30日18岁以上住院患者26560例进行深静脉血栓危险程度评估，对中等以上危险因素（评分〉3分）的需手术患者共l235例进行围手术期预防性应用低分子肝素钠；对照组对2009年8月1日-2011年7月21日18岁以上住院患者21431例，中等以上危险因素（评分〉3分）的手术患者共2037例，未采取任何预防措施；分析两组患者术后深静脉血栓的发生情况。结果：观察组术后发生深静脉血栓ll例，发病率为0．89％；对照组术后发生深静脉血栓68例，发病率为3．34％；两组患者差异有显著性，有统计学意义（P〈O．05）。结论：应用《青海红十字医院深静脉血栓危险因素评估表》对住院患者进行评估，对于中等以上危险（评分〉3分）的需手术患者进行围手术期预防性应用低分子肝素钠，明显降低了深静脉血栓发生率。

Assessment and Prevention of Risk Factors of Deep Venous Thrombosis

To assess the risk grade of deep venous thrombosis （DVP） for reducing the rate of DVP occurrence by carrying out preventive procedure. Method：In order to establish the DVP risk assessment form suit- able for Xining area （2 264m above sea level）, we based on the American preventive medical advice for DVP and the references concerning DVP in Asia, 26 560 cases patients （over 18 years old） administrated in our hospital from July 2011 to June 2013 as the trial group were assessed. Among them, 1 235 patients who need to be operated and the risk score above middle grade （ assessment score 〉 3） were injected low molecular weight heparin for peri- operative DVT prevention. 21 431 cases patients （over 18 years old） administrated in our hospital from august 2009 to July 2011 as the control group were assessed. Among them, 2 037 patients who need to be operated and the risk score above middle grade （assessment score 〉 3） had not been taken any other preventive measures. And then the situation of DVT occurrence after operation in both groups was analyzed. Result： 11 cases of DVT onset was appeared in trial group after operation, the incidence rate was 0.89% ; whereas, 68 cases of DVT onset was ap- peared in control group after operation, the incidence rate was 3.34%. There was a significant difference between the two groups （P 〈 0.05）. Conclusion： Applying the Qing Hal Red Cross Hospital DVT assessment to assess the hospitalized patients who need to be operated and the risk score is above middle grade and by injecting the low mo- lecular weight heparin has remarkably reduced the incidence of DVT.