妇科患者静脉血栓栓塞症危险因素的评估及风险预警评分表的构建

Evaluation of risk factors of venous thromboembolism in gynecological patients and construction of risk early warning scale

目的探索妇科患者术后发生静脉血栓栓塞症(VTE)的危险因素,构建并验证妇科VTE风险预警评分表。方法回顾性分析2017年1月—2019年12月上海市奉贤区中心医院完成妇科手术患者的临床资料,筛选发生VTE的53例患者为病例组,以同科室、同期住院为配比条件按1∶3的配比选择未发生VTE病例167例为对照组。分析妇科患者术后发生VTE的危险因素,构建并验证妇科VTE风险预警评分表。结果两组年龄、高血压、高血脂、术中输血、手术时间、卧床时间、病症种类、服用避孕药占比比较,差异有统计学意义(P<0.05)。年龄≥60岁、高血压、服用避孕药、高血脂、手术时间≥180 min、卧床时间≥96 h、恶性肿瘤是VTE发生的危险因素(OR>1,P<0.05)。构建的妇科VTE风险预警评分表标准为低风险<2.8分,高风险≥2.8分。两组不同风险分级占比比较,差异有统计学意义(P<0.05)。结论妇科患者并发VTE的危险因素较复杂,风险预警评分表可以用于预防和减少妇科手术患者的VTE发生率,易于在临床上应用。

Objective To explore the risk factors of postoperative venous thromboembolism(VTE)in gynecological patients,and to construct and verify the risk early warning scale of gynecological VTE.Methods Clinical data of patients who underwent gynecological surgery in Shanghai Fengxian District Central Hospital from January 2017 to December 2019 were retrospectively analyzed.Fifty-three patients with VTE were selected as the case group,and 167 patients without VTE were selected as the control group according to the ratio of 1∶3 in the same department and hospitalized at the same time.The risk factors of postoperative VTE in gynecological patients were analyzed,and the risk early warning scale of gynecological VTE was constructed and verified.Results There were statistically significant differences between the two groups in the proportion of age,hypertension,hyperlipidemia,intraoperative blood transfusion,operative time,bed time,disease types and use of contraceptives(P<0.05).Age≥60 years old,hypertension,use of contraceptives,hyperlipidemia,operation time≥180 min,bed time≥96 h,malignant tumor were risk factors for VTE(OR>1,P<0.05).The standard of gynecological VTE risk early warning scale constructed was low risk<2.8 points and high risk≥2.8 points.There was statistical significance in the proportion of different risk grades between the two groups(P<0.05).Conclusion The risk factors of gynecological patients complicated with VTE are complex.The risk early warning scale can be used to prevent and reduce the incidence of VTE in gynecological surgery patients,and is easy to be applied in clinical practice.