血栓弹力图联合Caprini模型评估结直肠癌患者术后深静脉血栓形成的风险

Evaluation of Risk of Postoperative Deep Vein Thrombosis in Patients with Colorectal Cancer by Thromboelastogram Combined with Caprini Model

目的探讨血栓弹力图联合Caprini模型评估结直肠癌患者术后深静脉血栓(DVT)形成的风险。方法选取东莞市人民医院2017年4月至2019年10月收治的133例结直肠癌患者,术前采用Caprini模型进行评分,术后第3天进行血栓弹力图检测,以Caprini评分及血栓弹力图指标[凝血反应时间(R)、凝血形成时间(K)、血凝块形成速率(α角)、最大凝块强度(MA)、凝血综合指数(CI)]评估患者DVT形成情况,分析Caprini评分、CI及两者联合评估患者术后DVT形成风险的曲线下面积(AUC)。结果结直肠癌患者Caprini评分≥3分可能出现DVT的概率大于0~2分(P<0.05)。DVT组R、K均短于未出现DVT组,α角、MA、CI均大于未出现DVT组(P<0.05)。Caprini评分、CI评估DVT形成风险的AUC分别为0.789、0.818,二者联合评估的AUC为0.886,Caprini评分联合CI评估结直肠癌患者术后DVT风险的效能高于二者单独评估(P<0.05)。结论血栓弹力图联合Caprini模型可以更加准确评估结直肠癌患者术后DVT形成的风险,值得临床推广。

Objective To evaluate the risk of postoperative deep vein thrombosis(DVT)in patients with colorectal cancer by thromboelastogram combined with Caprini model.Methods A total of 133 patients with colorectal cancer admitted to Dongguan People’s Hospital from April 2017 to October 2019 were enrolled and scored with the Caprini model before surgery,and the thromboelastogram was performed on the third day after operation.Caprini score and thromboelastogram indexes included clot reaction time(R),clot formation time(K),blood clot formation rate(αangle),maximal amplitude(MA),coagulation index(CI)and other indicators were used to evaluate the DVT of patients.The areas under the curves(AUCs)of Caprini score,CI and their combination to evaluate the risk of DVT after operation were analyzed.Results Patients with colorectal cancer with Caprini score≥3 points may have a greater DVT rate than those with Caprini score of 0 to 2 points(P<0.05).The R and K of DVT group were both shorter than those of non-DVT group,and theαangle,MA and CI were all larger than those of non-DVT group(P<0.05).The AUCs of Caprini score and CI to evaluate the risk of DVT were 0.789 and 0.818,respectively,and the AUC of their combination was 0.886.The efficacy of Caprini score combined with CI in evaluating the risk of postoperative DVT in patients with colorectal cancer was higher than that of both alone(P<0.05).Conclusion Thromboelastography combined with Caprini model can more accurately assess the risk of postoperative DVT in patients with colorectal cancer,which is worthy of clinical promotion.