妇科恶性肿瘤手术患者静脉血栓栓塞症危险因素分析及风险评估表的应用

Risk factors analysis of venous thromboembolism in post-operative patients with gynecological malignant tumor and application of related risk assessment table

目的探讨妇科恶性肿瘤手术患者并发静脉血栓栓塞症(VTE)的危险因素,并评价《住院患者静脉血栓栓塞症风险评估表》在妇科恶性肿瘤手术并发VTE患者中的应用价值。方法选取我院2010年10月至2015年11月期间收治的妇科恶性肿瘤手术患者530例,其中确诊并发VTE者58例,未并发VTE者472例,根据患者年龄、体质量指数(BMI)、肿瘤类型、肿瘤分期、手术方式、手术时长、出血量、有无输血、卧床时间、有无合并症等因素进行统计学分析。应用我院多学科联合制定的新版《住院患者静脉血栓栓塞症风险评估表》对2015年11月至2017年4月收治的317例妇科恶性肿瘤手术患者进行围手术期的动态评估,根据评估结果采取针对性的干预措施,统计VTE的发生率并与未应用评估表的患者进行比较。结果单因素分析结果显示,妇科恶性肿瘤手术患者并发VTE与BMI、肿瘤分期、手术时长、出血量、有无输血、卧床时间有关(P<0.05);多因素分析结果显示,年龄、BMI、肿瘤分期、手术时长、手术方式是影响妇科恶性肿瘤手术患者并发VTE的独立危险因素(P<0.05)。应用新版《住院患者静脉血栓栓塞症风险评估表》进行评估并采取针对性措施后,VTE的发生率低于应用前[1.89%(6/317)vs 10.9%(58/530)],差异具有统计学意义(P<0.05)。结论年龄、BMI、肿瘤分期、手术时长、手术方式是影响妇科恶性肿瘤手术患者并发VTE的独立危险因素。通过在围手术期有效评估VTE发生风险,根据风险评分采取相应有效预防措施,可降低妇科恶性肿瘤手术患者VTE的发生率。

ObjectiveTo investigate the risk factors of venous thromboembolism(VTE)in post operative patients with gynecological malignant tumors,and to evaluate the value of Risk Assessment Table of VTE in Hospitalized Patients in above patients.MethodsA total of530post operative patients with gynecological malignant tumors in our hospital between Oct.2010and Nov.2015were enrolled,including58cases complicated with VTE and472cases without VTE.Clinical indexes of all patients including age,body mass index(BMI),tumor type,tumor stage,operation method,operation time,amount of bleeding,history of blood transfusion,bedridden time,and history of comorbidities were statistically analyzed.The clinical dynamic evaluation of317post operative patients with gynecological malignant tumor diagnosed between Nov.2015and Apr.2017were conducted by the new version of Risk Assessment Table of VTE in Hospitalized Patients,which was jointly developed by our hospital.Targeted interventions were used based on the evaluation results,and the incidence of VTE was observed and compared with patients who did not use the assessment table.ResultsUnivariate analysis results showed that BMI,tumor stage,operation time,amount of bleeding,blood transfusion and bedridden time were significantly related to VTE(P<0.05).Multivariate analysis results showed that age,BMI,tumor stage,operation time and operation method were independent risk factors of VTE in post operative patients with gynecological malignant tumor(P<0.05).After application of the Risk Assessment Table of VTE in Hospitalized Patients and taking corresponding interventions,the incidence of VTE in patients was significantly lower than that before application(1.89%[6/317]vs10.9%[58/530],P<0.05).ConclusionAge,BMI,tumor stage,operation time and operation method are the independent risk factors of VTE in post operative patients with gynecological malignant tumor.Assessing the risk of VTE in the peri operative period and taking appropriate preventive measures according to the risk score can reduce the incidence of VTE in post operative patients with gynecological malignancies.