血栓风险因素评估表对重型颅脑创伤术后昏迷患者静脉血栓栓塞症的预防作用

Caprini model for prevention of venous thromboembolism in coma patients after surgery for severe traumatic brain injury

目的分析血栓风险因素评估表(Caprini模型)对重型颅脑创伤术后昏迷患者静脉血栓栓塞症(VTE)的预防作用。方法选取丽水市人民医院2015年1月至2019年4月收治的重型颅脑创伤患者190例为观察对象,采用随机数字表法分成对照组和观察组,每组95例。对照组采取常规下肢VTE预防策略,观察组根据Caprini模型评估结果采取个体化的下肢VTE预防策略。比较两组患者研究中途脱落情况及治疗结局;比较两组入住重症医学科期间VTE的发生例数以及凝血指标变化。结果对照组研究中途脱落率为10.53%(10/95),观察组为8.42%(8/95),两组脱落率比较,差异无统计学意义(χ^(2)=0.245,P<0.05);观察组入住重症医学科期间VTE发生率为2.30%(2/87),明显低于对照组的10.59%(9/85),差异有统计学意义(χ^(2)=4.935,P<0.05)。观察组术后第7天的凝血指标D-二聚体(D-D)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)分别为(2.27±0.43)mg/L、(281.62±37.29)×10^(9)/L、(12.93±2.87)s、(34.35±7.19)s,对照组分别为(3.31±0.68)mg/L、(303.28±39.96)×10^(9)/L、(11.24±2.46)s、(31.16±6.82)s,观察组各项凝血指标均明显优于对照组,均差异有统计学意义(t=10.013、3.070、-3.463、-2.493,均P<0.05)。结论Caprini模型对重型颅脑创伤术后昏迷患者VTE的预防效果明显,值得推荐。

Objective To analyze the preventive effect of Caprini model on venous thromboembolism(VTE)in coma patients after severe craniocerebral trauma.Methods A total of 190 patients with severe craniocerebral trauma who received treatment in Lishui City People's Hospital,China between January 2015 and April 2019 were randomly divided into a control group and an observation group(n=95/group).Patients in the control group underwent the conventional strategy to prevent lower extremity VTE.Patients in the observation group were subjected to individualized strategies to prevent lower extremity VTE based on Caprini model assessment.The drop-out rate and treatment outcome were compared between the control and observation groups.The proportion of patients developing VTE during treatment in Department of Intensive Care Unit and the changes in coagulation indexes relative to before treatment were compared between the two groups.Results There was no significant difference in drop-out rate between the control and observation group[10.53%(10/95)vs.8.42%(8/95),χ^(2)=0.245,P<0.05].The proportion of patients developing VTE in the observation group was significantly lower than that in the control group[2.30%(2/87)vs.10.59%(9/85),χ^(2)=4.935,P<0.05].At 7 days after surgery,the coagulation indices D-dimer,platelet count,prothrombin time,activated partial thromboplastin time in the observation group were(2.27±0.43)mg/L,(281.62±37.29)×10^(9)/L,(12.93±2.87)seconds and(34.35±7.19)seconds,respectively,which were(3.31±0.68)mg/L,(303.28±39.96)×10^(9)/L,(11.24±2.46)seconds and(31.16±6.82)seconds,respectively in the control group.The coagulation indices in the observation group were significantly superior to those in the control group(t=10.013,3.070,-3.463,-2.493,all P<0.05).Conclusion The Caprini model is effective in preventing VTE in patients with coma after surgery for severe traumatic brain injury.It deserves to be clinically applied.