中国胸外科术后静脉血栓栓塞症现状的问卷调查分析

Survey of current status of prevention of venous thromboembolism after thoracic surgery in China

目的 了解中国胸外科术后静脉血栓栓塞症（VTE）防治现状.方法 以微信作为调查平台,对中国胸外科医师行网络问卷调查,问卷在国际胸外科血栓调查问卷的中文版基础上添加了有中国特色、符合中国国情的6个问题.结果 共回收有效问卷1 150份,被访问医师地域分布广、学历职称高、工作经验丰富.对于肺癌患者,66.96％（770/1 150）的医师认为术后VTE的预防应从术后1d开始,64.61％ （743/1 150）的医师认为其应延续至出院后;对于食管切除患者,48.35％（514/1 063）的医师认为食管癌患者出院后无需继续预防VTE.超过半数的医师依靠临床经验决定肺癌[53.91％（620/1 150）]和食管癌[52.49％（558/1 063）]术后VTE预防方式和时长.低分子肝素是大部分医师选择的预防术后VTE的常规抗凝方式.超过半数医师认为,既往VTE病史、高龄、易栓症、肥胖（体重指数＞30 kg/m^2）、手术时间＞6h和VTE家族史是肺癌术后选择进行VTE预防的重要因素.结论 本次问卷调查可基本反映中国胸外科VTE防治的现状,为我国胸外科术后VTE防治从国家政策制定、医院防治架构建设和医师个人认知提高等不同层面提供数据支持.

Objective To investigate the current status of prevention and treatment of venous thromboembolism （VTE） after thoracic surgery in China.Method Chinese thoracic surgeons were investigated by the online questionnaire which was based on the Chinese version of International VTE questionnaire added with 6 extra questions with Chinese characteristics.Results A total of 1 150 valid questionnaires were retrieved,accounting for about 20% of all the Chinese thoracic surgeons.The surgeons participating in this survey came from all over the country,most of whom were experienced professionals with high academic titles.For lung cancer patients,66.96% （770/1 150） of the surgeons suggested that VTE prophylaxis should start 1 day after lung cancer resection,and 64.61% （743/1 150） of the surgeons suggested extending after discharge.For esophagestomy patients,and 48.35% （514/1 063） of the surgeons suggested that there was no need for patients to extend VTE prophylaxis after discharge.More than half of the surgeons participating in this survey made decision of the method and duration of VTE prophylaxis after lung cancer resection （53.91% （620/1 150）） or esophagectomy （52.49% （558/1 063）） depending on the clinical experience.Low molecular weight heparin was the common choice of most surgeons in VTE prophylaxis.More than half of the surgeons thought that previous history of VTE,advanced age,complicated with thrombophilia,obesity （body mass index 〉 30 kg/m2）,duration of surgery longer than 6 hours and family history of VTE were key risk factors of the occurrence of postoperative VTE.Conclusions The results of this survey are highly credible and are a good reflection of the current status of VTE prevention and treatment after thoracic surgery in China.This survey will play an important role in promoting VTE prevention and treatment in Chinese thoracic surgery department,it will also provide data support for government setting new policies,hospital construction of VTE prevention and control as well as raising physicians＇ awareness.