Caprini和Rogers血栓风险评估模型在胸外科肺癌患者围手术期应用的验证研究

Application of Caprini and Rogers Risk Assessment Models in the Perioperative Management of Lung Cancer Patients

目的:对Caprini和Rogers血栓风险评估模型在胸外科肺癌患者围术期筛查静脉血栓栓塞症(venous thromboembolism,VTE)高风险的适用性进行分析,以验证其有效性。方法:纳入2015年3月至2017年3月在四川省肿瘤医院胸外科中心接受手术治疗的肺癌患者,术后未预防性抗凝处理。所有患者围术期行双下肢血管彩超检查,怀疑肺血管栓塞者行胸部CT检查,前瞻性收集临床和实验室相关指标。以Caprini和Rogers血栓风险评估量表对所有患者进行血栓风险评分。分别分析Caprini和Rogers评分不同层级组之间术后VTE发生率、危险因素、实验室指标的差异。结果:152例肺癌患者入选本研究,术后深静脉血栓(deep vein thrombosis,DVT)发生率25%(38/152),无肺栓塞发生。全组患者Caprini评分为8~15分,均至少为VTE高风险层级,其中高危组(5~8分) 66例,极高危组(>9分) 86例;两组DVT发生率为27. 3%vs 23. 3%(P=0. 46),差异无统计学意义。全组Rogers评分6~18分,其中低危组(7~10分) 67例,中高危组(> 10分) 85例;低危组与中高危组DVT发生率为25. 4%vs 24. 7%(P=0. 64),差异无统计学意义。Caprini评分高危组与极高危组之间和Rogers评分低危组与中高危组之间在DVT危险因素年龄、胸引管留置时间、吸烟指数、血型构成、合并慢性阻塞性肺疾病病史、组织学类型、电视胸腔镜辅助手术、手术时间、术后卧床时间、病理学分期的差异均无统计学意义(P>0. 05);在围术期各时点的凝血指标及中性-淋巴细胞比值的差异亦无统计学意义。结论:Caprini血栓风险评估模型评价胸外科肺癌手术患者易评为VTE高风险人群,对预防VTE具有积极的指导意义,但Caprini和Rogers血栓风险评估模型对胸外科肺癌患者围术期VTE风险层级评估的有效性尚不确切,应探索建立符合我国肺癌人群特质的胸外科血栓风险评估量表体系。

Objective: To analyze the applicability of Caprini and Rogers risk assessment models for venous thromboembolism(VTE) in the perioperative management of for lung cancer patients in the Department of Thoracic Surgery,and verify the validity of the two models. Methods: Lung cancer patients undergoing surgery in the Department of Thoracic Surgery in Sichuan Cancer Hospital from March 2015 to March 2017 were enrolled according to the inclusion criteria. No patient received postoperative prophylactic anticoagulation. All patients underwent vascular ultrasound of the legs in the perioperative period. Patient with suspected pulmonary embolism(PE) underwent computed tomography scan. Clinical and laboratory indexes were collected prospectively. Caprini and Rogers risk assessment models were used for all patients to assess the risk of VTE. Incidence and risk factors of VTE were analyzed. Differences in the incidence and risk factors of postoperative VTE and laboratory indexes between the two groups were analyzed. Results: A total of 152 patients were enrolled in this study.The incidence of postoperative deep vein thrombosis(DVT) was 25%(38/152),and no PE occurred. All patients with Caprini scores of 8-15 were most commonly at high risk for VTE,including 66 cases in the high-risk group(5-8 points) and86 cases in the extremely high-risk group(> 9 points). Difference in the incidence of DVT between the two groups was not significant(27. 3% vs 23. 3%,P = 0. 46). The Rogers scores ranged from 9 to 18 across all patients including 67 cases in the low-risk group(7-10 points) and 85 cases in the moderate-risk group(> 10 points). There was no significant difference in the incidence of DVT between the two groups(25. 4% vs 24. 7%,P = 0. 64). Significant differences were found neither in the risk factors of DVT(age,smoking index,blood type,history of chronic obstructive pulmonary disease,histological type,video-assisted thoracoscopic surgery,operation time,postoperative bed rest time and pathologic stage) nor in perioperative D-dimmer levels,fibrinogen levels,fibrinogen degradation products and neutral-lymphocyte ratio between the Caprini high-risk and the Caprini extremely high-risk groups or between the Rogers low-risk group and the Rogers moderately high-risk group. Conclusion: Caprini venous thromboembolism risk assessment model tends to evaluate the lung cancer patients undergoing thoracic surgery as high-risk of VTE. It is highly significant in guiding the prevention of VTE. Caprini and Rogers risk assessment models,however,are inexact in risk stratification of VTE for perioperative lung cancer patients in the Department of Thoracic Surgery. It is necessary to establish a new system of thrombosis risk assessment suitable for Chinese lung cancer patients’ characteristics.