新疆某骨科医院手术患者静脉血栓栓塞发生的高危因素探讨及预警模式研究

Study on Risk Factors and Early Warning Mode of Venous Thromboembolism in Surgical Patients in an Orthopedic Hospital at Xinjiang Area

目的探讨新疆某骨科专科医院手术患者静脉血栓栓塞(vellous thromboembolism,VTE)发生的高危因素,通过统计数据建立预警机制,为后期的VTE预防提供参考资料。方法 2013年1月至2016年12月,使用病例-队列研究模式收集骨科手术患者共计356例,根据随访2月内是否发生VTE分为病例组与对照组,收集患者的一般资料、临床资料、治疗资料等,分析高危因素。根据高危因素结果及OR值权重建立预警模型。结果 a)相对于汉族而言,维吾尔族、哈萨克族为骨科手术后VTE发生的高危因素(OR分别为1.844,3.569);相对于城区而言,农村居民为骨科手术后VTE发生的高危因素(OR=6.083);相对于小学文化而言,初中、高中、大学及以上文化程度为骨科手术后VTE发生的保护因素(OR分别为0.774,0.154,0.319);术中输液、输血为术后VTE发生高危因素(OR分别为1.642,3.833);止血药物的应用为术后VTE发生的高危因素(OR=3.884);预防性溶栓药物的应用为骨科术后VTE发生的保护因素(OR=0.266);b)病例组的年龄、体重、体重指数(body mass index,BMI)均高于对照组(P<0.05);c)骨科手术患者VTE发生的高危因素有:居住地为农村、术中有输血、有止血药物的应用、BMI大于20kg/m^2、年龄大于50岁、体重大于58kg、术中有输液者。保护性因素有患者学历为高中及以上、有预防性溶栓药物应用。d)建立预警模式后,通过ROC曲线证实模型有效,评分大于16.5分时,应评价为高风险。结论通过本次研究建立的风险预警机制可以在临床上加以应用,以减少患者发生VTE的概率,提高预后。

Objective To investigate the high risk factors of venous embolization surgery thrombosis（VTE）in orthopedics patients at Xinjiang,to establishment of early warning mechanism based on statistical data,to provide reference for the prevention.Methods From January 2013 to December 2016,we collected data of 356 cases using a case cohort study model.According to the result of 2 month follow-up,the patients were divided into case group（VTE occur）and control group（no VTE occur）.General information,clinical data,treatment data were collected.And we analyzed the risk factors using the data.An early warning model was established based on the results of high-risk factors and the weights of OR values.Results Compared with the Han,Uygur and Kazak was a risk factor for the occurrence for VTE occurrence（OR=1.844,3.569）.Compared with the urban,rural residents was a risk factor for VTE occurrence（OR=6.083）.Compared with the Lower education cases,higher education was a protection factor.Infusion and blood transfusion were risk factors of VTE（OR=1.642,3.833）.The application of hemostatic drugs were high risk factors for the occurrence of VTE surgery（OR=3.884）.Thrombolytic drugs use were protect factor for VTE occurrence（OR=0.266）.Case group＇s age,weight and BMI were significantly higher than control group（P〈0.05）.High risk of VTE for surgical patients in the department of orthopedics were residence in rural areas,intraoperative blood transfusion,hemostatic drugs used,BMI greater than 20,older than 50 years old,weight greater than 58 kg,intraoperative infusion.Protective factors include patients with high school education and preventive drug.The early warning model was validated by the ROC curve,and patients with the score higher than 16.5 points was in high risk.Conclusion The risk warning mechanism established in this study can be applied clinically to reduce the incidence of VTE and improve the prognosis in Xinjiang aera.