肺癌术后并发静脉血栓栓塞危险因素及抗凝药使用临床分析

Risk Factors of Venous Thromboembolism After Lung Cancer Surgery and the Use of Anticoagulants

目的研究肺癌术后并发静脉血栓栓塞(VTE)的危险因素,促进其抗凝药的合理使用。方法选取医院2016年3月至2018年3月收治并接受肺癌根治术治疗的患者198例,按术后是否并发VTE分为VTE组(24例)及非VTE组(174例)。对比两组患者的一般资料,并进行影响肺癌术后并发VTE的多因素Logistic回归分析,同时分析VTE组患者抗凝药的使用情况。结果VTE组肺部合并疾病人数百分比及D-二聚体、白细胞计数(WBC)水平显著高于非VTE组(P<0.05),住院时间显著长于非VTE组(P<0.05),红细胞(RBC)水平显著低于非VTE组(P<0.05);经多因素Logistic回归分析可知,住院时间超12 d、D-二聚体水平升高、RBC水平降低均是肺癌术后并发VTE的独立危险因素(P<0.05);VTE组患者的抗凝药不合理用药人数占比为41.67%(10/24)。结论肺癌术后并发VTE的危险因素较多,其中住院时间超12 d、D-二聚体水平升高、RBC水平降低均为独立危险因素;且抗凝药合理使用情况并不乐观,应针对有关危险因素加以改进,降低VTE发生风险。

Objective To study the risk factors of venous thromboembolism(VTE)after lung cancer surgery and to promote the rational use of anticoagulants.Methods Totally 198 patients underwent radical resection of lung cancer in our hospital from March 2016 to March 2018 were selected and divided into the VTE group(n=24)and the non-VTE group(n=174)according to whether they were complicated with VTE after surgery.The general data of the two groups were compared,and multivariate Logistic regression analysis of influence of postoperative VTE on lung cancer was performed.In addition,the use of anticoagulants in patients with VTE group was analyzed.Results The percentage of patients with pulmonary diseases,the levels of D-dimer and white blood cell count(WBC)in the VTE group were significantly higher than those in the non-VTE group,while the length of stay in the VTE group was significantly longer than that in the non-VTE group(P<0.05),the level of red blood cell(RBC)in the VTE group was significantly lower than that in the non-VTE group(P<0.05).Multivariate Logistic regression analysis showed that the length of stay>12 d,increased D-dimer and decreased RBC were independent risk factors for VTE after lung cancer surgery(P<0.05).In the VTE group,41.67%(10/24)of the patients took anticoagulants irrationally.Conclusion There are many risk factors of VTE after lung cancer surgery,among which the length of stay>12 d,increased D-dimer and decreased RBC were independent risk factors,and the rational use of anticoagulants in patients is not optimistic,we should improve the rational use of anticoagulants according to the risk factors to reduce the risk of VTE.