摘要
目的分析Caprini血栓风险评估模型在非转移性肺癌手术后患者静脉血栓栓塞症(VTE)筛选中的有效性。方法回顾性分析2015年10月至2017年10月收治的肺癌术后患者136例,并随访2个月,根据随访结果分为VTE组(39例)和非VTE组(97例)。其中VTE组根据栓塞类型再分为肺栓塞(PE)组(5例)和深静脉血栓形成(DVT)组(34例)。对比分析不同组一般临床资料、手术相关参数以及Caprini评分的差异性。运用单因素分析评估Caprini血栓风险评估模型中的相关临床参数中与术后发生VTE的危险因素,将单因素中具有统计学意义的参数纳入到多因素分析中评估发生VTE的独立危险参数。结果28.2%(11/39)的VTE事件发生在出院后。VTE组的住院时间和Caprini风险评分分别为(16.3±3.6)d、(10.5±2.4)分,均高于非VTE组的(8.9±3.4)d、(9.3±2.1)分,差异有统计学意义(t=11.287、2.891,P<0.01),在VTE事件中PE组的发病时间提前(P=0.019),并且住院时间和Caprini评分均差于DVT组(P<0.05)。Caprini风险评分中高危风险截止值为9分时,准确度为76.5%,阳性预测值为58.1%,阴性预测值为84.9%,敏感度和特异度分别为64.1%和81.4%。Caprini血栓风险评估模型中的相关临床参数的多因素分析结果显示下肢肿胀(P<0.01),静脉曲张(P<0.01),脓毒症(P<0.01),严重急性肺病(P<0.01),充血性心力衰竭(P<0.01),中心静脉置管(P<0.01)以及VTE病史(P<0.01)均是与VTE事件相关的独立危险因素。中危和高危的肺癌术后患者VTE的发病风险是低危风险患者的3.5倍和8.4倍。结论在术后护理过程中结合Caprini血栓风险评估模型最有可能预测肺癌术后患者发生VTE的发病风险,并且使用9分作为Caprini血栓风险评分中高风险的截止值具有更好的敏感性和特异性。
Objective To analyze the effectiveness of Caprini thrombosis risk assessment model in the screening of patients with non-metastatic lung cancer after venous thromboembolism (VTE).Methods A retrospective analysis of 136patients with postoperative lung cancer who were admitted to our department between October 2015and October 2017was followed up for 2months.According to the follow-up results,the patients were divided into VTE group and non-VTE group.The VTE group was further divided into the PE group and the deep venous thrombosis (DVT)group according to the embolization type.Comparisons were made between the two groups for general clinical data,surgically related parameters,and differences in Caprini scores.Univariate analysis was used to assess the risk factors associated with postoperative VTE in the relevant clinical parameters in the Caprini thrombosis risk assessment model.Statistically significant parameters in the single factor were included in multivariate analysis to assess independent risk parameters for VTE.Results There were 39cases in VTE group and 97cases in non-VTE group.Among them,28.2%(11/39)of VTE events occurred after discharge.The hospitalization time and Ca'prini risk scores in VTE group were (16.3±3.6)days,(10.5±2.4)points,which were significantly higher than (8.9±3.4)days,(9.3±2.1)points in non-VTE group (t=11.287, 2.891,P<0.01).In the VTE event,the onset time in the PE group was significantly advanced (P=0.019), and both the length of hospital stay and Caprini score were significant.It was worse than DVT group (P< 0.05).When Caprini's high-risk risk cut-off was 9points,the accuracy was 76.5%,the positive predictive value was 58.1%,the negative predictive value was 84.9%,and the sensitivity and specificity were 64.1% and 81.4%,respectively.Multivariate analysis of relevant clinical parameters in the caprini thrombosis risk assessment model showed swelling in the lower extremities (P<0.01),varices (P<0.01),sepsis (P< 0.01),and severe acute lung disease (P<0.01).Congestive heart failure (P<0.01),central venous catheter (P<0.01),and VTE history (P<0.01)were all independent risk factors associated with VTE events.The risk of developing VTE in postoperative patients with moderate-and high-risk lung cancer was 3.5and 8.4 times higher than that in low-risk patients.Conclusion Combining the Caprini thrombosis risk assessment model during postoperative care is most likely to predict the risk of developing VTE in postoperative patients with lung cancer,and the use of 9points as a high-risk cutoff for the Caprini Thrombotic Risk Score has better sensitivity and Specificity.
作者
李静
徐敏
LiJing;Xu Min(Department of Thoracic Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200093,China)
出处
《中国实用护理杂志》
2018年第35期2753-2758,共6页
Chinese Journal of Practical Nursing
