3种血栓风险评估表对骨科大手术患者下肢深静脉血栓形成的应用价值研究

The study of application value of three risk assessment forms in major orthopedic surgery patients with lower extremity deep venous thrombosis

目的比较3种血栓风险评估表对骨科大手术患者术后下肢深静脉血栓形成(DVT)的预测价值,筛选适宜骨科大手术患者使用的血栓风险评估工具。方法采用回顾性病例对照研究,选取2014年6-12月在重庆某三甲医院行骨科大手术的185例患者为研究对象,将确诊下肢DVT的48例为DVT组,未发生下肢DVT的137例患者为对照组,分别采用Wells、Caprini、Autar血栓风险评估表对患者进行血栓风险评分,绘制受试者工作特征曲线(ROC),应用ROC曲线分析和Z检验评价3种血栓风险评估表对骨科大手术人群下肢DVT的预测价值。结果Wells、Caprini、Autar 3种血栓风险评估表的ROC曲线下面积(AUC)分别为(0.958±0.019)、(0.680±0.046)、(0.723±0.038),其中Wells评估表的AUC与另外两种评估表比较差异均有统计学意义(P<0.05),而Caprini与Autar比较差异无统计学意义(P>0.05)。结论 Wells风险评估表对骨科大手术患者下肢DVT的风险预测能力最高,更适合临床医生对DVT的诊断和鉴别诊断。而其余两种更适宜临床护理人员筛查应用。

Objective To compare the predictive value of three risk assessment forms in major orthopedic surgery patients with lower extremity deep venous thrombosis （DVT）,and to screen out the most suitable tools for risk assessment of DVT.Methods A total of 185 patients were selected.Among them,48 cases which were diagnosed as lower limb DVT were selected as the DVT group,and 137 patients without lower DVT were selected as the control group,data from patients in the hospital was analyzed from Jun.to Dec.2014.Using three risk assessment models,including scales of Wells,Caprini and Autar,and though drawing receiver operating characteristic （ROC） curve and Z-test,the risk of happening DVT in patients with major orthopedic surgery was analyzed.Results ROC analysis displayed that the areas under the curve （AUC） of Wells,Caprini and Autar were （0.958±0.019）,（0.680±0.046） and （0.723±0.038）,respectively.There were significant differences between Wells score and the other two scales （P〈0.05）.However,there was no significant difference between Caprini and Autar in AUC（P〉0.05）.Conclusion Wells has the highest predictive value in assessing the risk of DVT in patients with major orthopedic surgery.It is more suitable for the diagnosis and differential diagnosis of patients with DVT.The rest of the two are more suitable for clinical nursing staffs to screen out DVT.