中国结直肠外科术后静脉血栓栓塞症现状问卷调查分析

Questioniare analysis of the status of venous thromboembolism after colorectal surgery in China

目的了解我国结直肠外科医师对于静脉血栓栓塞症(VTE)的认知程度、相关指南的了解程度以及临床抗凝预防的现状。方法2019-10-28—2019-12-02采用微信问卷调查方式,从基本信息、VTE防治现状、结直肠围手术期VTE防治、VTE相关知识测试四个方面设计问卷,针对我国29个省、市、直辖市的结直肠外科医师进行网络问卷调查,共收集44份问卷。结果共收集有效问卷338份,90.82%(307/338)被调查者来自三级医院,参与调查者来自29个省、自治区和直辖市(三级医院307名,二级医院31名)。被调查医师中,94.67%(320/338)曾收治VTE病人,99.41%(336/338)认为在临床工作中需要遵循VTE指南和规范,但34.62%(117/338)的医师认为执行难度较大。83.73%(283/338)被调查者对结直肠手术病人进行VTE风险评估,主要的评估工具为Caprini评分。99.11%(335/338)认为规范预防VTE可使病人获益,78.4%(265/338)会常规或经常对结直肠病人进行VTE预防,采取的预防措施依次为:增加自主活动(87.69%,292/333)、抗凝药物(87.09%,290/333)、机械预防(76.28%,254/333)。药物预防主要选择为低分子肝素(96.4%,321/333),主要选择依据为药物安全性(87.99%,293/333),使用抗凝药物的主要顾虑为增加出血事件(74.77%,249/333)。抗凝治疗期间,86.19%(287/333)被调查者选择会对病人进行出血危险评估。95.27%(322/338)选择在出院时对病人或家属进行宣教。但针对VTE的防治知识测试中,问答正确率仅为15.09%~73.96%。结论我国三级医院的结直肠外科医师能够普遍重视VTE事件,也能够遵循指南进行VTE的预防,但仍有部分医师在临床上根据个人经验治疗,有相当一部分医师对指南和共识的了解程度不够,有必要开展VTE防治的普及宣传,并开展结直肠外科病人VTE防治前瞻性研究。

Objective To investigate the understanding of venous thromboembolism(VTE)and the relevant guidelines among colorectal surgeons in China,and the current situation of clinical anticoagulation prevention.Methods By means of WeChat questionnaire,questionnaires were designed from four aspects including basic information,current situation of VTE prevention and treatment,VTE prevention and treatment in perioperative period of colorectal patients,and VTE related knowledge test between October 28,2019 and December 2,2019.A total of 444 questionnaires were conducted for colorectal surgeons from 29 regions in China.Results A total of 338 valid questionnaires were collected,of which 90.82%(307/338)were from tertiary hospitals,and participants came from 29 provinces.Among the surveyed colorectal surgeons,94.67%(320/338)had treated VTE patients,99.41%(336/338)believed that VTE guidelines should be followed in clinical work,but 34.62%(117/338)believed that implementation was difficult.And 83.73%(283/338)of them assessed the colorectal patients for VTE risk,with Caprini score as the main assessment tool.A total of 99.11%(335/338)believed that standardized prevention of VTE could benefit patients,and 78.4%(265/338)routinely or frequently prevented VTE in colorectal patients.The following preventive measures were taken:increased voluntary activity(87.69%,292/333),anticoagulant drugs(87.09%,290/333),mechanical prevention(76.28%,254/333).The main choice for drug prevention was low molecular weight heparin(96.4%,321/333),the main choice was based on drug safety(87.99%,293/333),and the main concern for coagulation was increased bleeding events(74.77%,249/333).During anticoagulant therapy,86.19%(287/333)evaluated patients for bleeding risk.A total of 95.27%(322/338)conducted relevant education for patients or their families when they were discharged from hospital.However,in the knowledge test of VTE prevention,the correct rate of answers only ranged from 15.09%to 73.96%.Conclusion Most of colorectal surgeons from tertiary hospitals in China generally pay attention to VTE events and can also follow the guidelines for VTE prevention.There are still some surgeons who treat patients based on their personal experience in clinical practice,and quite a few physicians do not have enough understanding of the guidelines and consensus.It is necessary to popularize the prevention and treatment of VTE,and to carry out a prospective study on the prevention and treatment of VTE in colorectal surgery patients.