Caprini血栓风险评估表评估妊娠期及产褥期静脉血栓栓塞疾病风险的有效性研究

Validity of Caprini risk assessment scale for assessing risk of venous thromboembolism in pregnancy and the puerperium

目的探讨Caprini血栓风险评估表预测妊娠期及产褥期静脉血栓栓塞疾病(venous thromboembolism,VTE)发病风险的有效性。方法采用病例对照研究,回顾性分析2004年1月至2015年12月入住福建医科大学附属第一医院的39例妊娠期及产褥期发生VTE的患者,作为病例组;随机选取同期妊娠期及产褥期非VTE患者156例作为对照组。根据Caprini血栓风险评估表对两组患者进行Caprini评分、危险度分级,分析危险度分级与VTE发病风险的相关关系,并分析Caprini风险评估量表中影响妊娠期及产褥期VTE发病的主要危险因素。结果妊娠期及产褥期血栓发生率为0.13%。病例组的VTE评分(5.7±2.9)高于对照组(3.6±1.7),差异有统计学意义(P<0.05)。病例组的高危和极高危级别所占比例最大,为94.8%,比例高于对照组(75.0%),两组Caprini危险度分级的构成之间差异有统计学意义(P<0.05)。Caprini风险评估量表的危险度分级与VTE发病存在显著的正相关关系(P<0.05),极高危级是影响VTE发病的主要危险因素。随着危险度分级的升高,妊娠期及产褥期患者发生VTE的风险随之升高。极高危(评分≥5)患者发生VTE的风险为低中危(评分0~2分)患者的16.107倍。Caprini风险评估表中的静脉曲张、BMI≥25、需卧床休息的内科患者、大手术(手术时间>45 min)是妊娠期及产褥期发生VTE的主要危险因素。结论Caprini血栓风险评估表在妊娠期及产褥期患者中也适用,对妊娠期及产褥期VTE发病风险有很好的预测性,在临床上适合推广应用。

Objective To test the validity of Caprini risk assessment scale in identifying the pregnancy and the puerperi- um patients with high venous thromboembolism （VTE） risks. Methods A case-control study was conducted in 39 VTE patients in pregnancy and the puerperium who were admitted to the First Affiliated Hospital of Fujian Medical Uni- versity from February 2004 to December 2015 in the case group, and a randomly selected group of 156 non-VTE pa- tients in pregnancy and the puerperium who were admitted during the same period served as controls.Caprini risk assess- ment scale was used to assess risk assessment and risk grading of venous thromboembolism.Logistic regression analysis was performed to establish the association between Caprini VTE risk calssification and the presence of VTE, and to find the risk factors for VTE.Results The incidence of the VTE patients in pregnancy and the puerperium was 0.13%.The VTE patients had a Caprini score of（5.7±2.9）, higher than that of the controls （3.6± 1.7）.More than 94.8% of VTE pa- tients were rated as having ＂high or very high＇risk of VTE by Caprini rating scale, significantly higher than the percent- age in the controls （P 〈 0.05 ）.The incidence of VTE in pregnancy and puerperium increased with an increase in risk lev- el.The odds ratio of VTE in patients w!th a very high risk as identified by Caprini score was 16.107, compared with those with a low and moderate risk. The logistic regression model identified four risk factors in the Caprini scale as predictors of VTE ：varicose veins, long-term lying in bed, obesity （BMI≥25） and major surgery （surgery time 〉 45 min）.Conclu- sion Caprini risk assessment scale ean predict the risk of VTE in pregnancy and puerperium patients.