药物预防对某医院骨科围手术期静脉血栓栓塞症发生率及病死率的影响

Incidence and Fatality of Venous Thromboembolism for the Pharmacological Thromboprophylaxis in the Perioperative Orthopedic Surgery in A Hospital

目的探讨某医院骨科围手术期患者使用抗凝药物预防对静脉血栓栓塞症(VTE)发生率和病死率的影响。方法选取2011年1月1日至2018年12月31日(8年)入住宁夏医科大学总医院骨科的手术患者。查阅入组患者全部诊断、手术操作、是否使用抗凝药物及合并症。分析围手术期VTE的发生率、肺栓塞(PE)相关病死率。结果8年间骨科手术患者共33914例,依据入排标准,最终入选27500例患者。围手术期抗凝药物使用的比例从26.38%上升至50.73%,其中99.73%的患者使用低分子肝素进行围手术期药物预防性抗凝。8年间发现骨科围手术期VTE的患者共367例,2011—2018年,VTE的患者从62例降至28例,相应的VTE发生率从2.08%下降至0.78%。2015—2018年(后4年)与2011—2014年(前4年)骨科住院患者资料对比,抗凝药物使用率较前4年增加(30.52%vs 44.05%,P<0.001),VTE发生率(1.66%vs 1.08%,P<0.001)、DVT发生率(1.51%vs 1.06%,P=0.001)、PE发生率(0.24%vs 0.10%,P<0.001)均较前4年下降。前、后4年围手术期死亡比例差异无统计学意义(0.07%vs 0.03%,P=0.265),后4年PE相关死亡比例较前下降(87.50%vs 20.00%,P=0.032)。结论骨科围手术期药物预防VTE的比例逐渐上升,相应的围手术期VTE发生率及PE相关病死率逐步下降,提示某医院骨科对VTE预防的重视程度逐年增高。

Objective To investigate incidence and fatality in perioperative patients with venous thromboembolism(VTE)for pharmacological prophylaxis in orthopedics surgery.Methods Patient data in orthopedics surgery was collected from General Hospital of Ningxia Medical University during January 1,2011 to December 31,2018(8 years).All diagnoses,surgical procedures,use of anticoagulants,and comorbidities were reviewed.The incidence and mortality of perioperative VTE as well as risk factors were further analyzed.Results 33914 patients were implemented with orthopedics surgery during 8 years.According with inclusion and exclusion criteria,there were 27500 subjects eligible for enrolment in this study.The proportion of perioperative anticoagulation increased from 26.38%to 50.73%.99.73%of patients were treated with LMWH for perioperative anticoagulation.A total of 367 cases from 2011 to 2018 were found with the diagnosis of VTE.The number of patients with perioperative VTE declined from 62 to 28,as years by the corresponding VTE incidence declined from 2.08%to 0.78%.Compared 2015 to 2018(the last four years)with 2011 to 2014(the first four years),there were significantly increased(30.52%vs 44.05%,P<0.001)in prophylaxis anticoagulation.The incidence of VTE(1.66%vs 1.08%,P<0.001),DVT(1.51%vs 1.06%,P=0.001),and PE(0.24%vs 0.10%,P<0.001)was decreased from the first four years.There was no significant difference in the proportion of perioperative deaths between the two groups(0.07%vs 0.03%,P=0.265),while the number of PE-related deaths in the last four years decreased regarding the previous ones(87.50%vs 20.00%,P=0.032).Conclusion The proportion of pharmacological prophylaxis in the perioperative orthopedics was increased gradually,while the incidence of VTE and the fatality related to PE decreased,which indicates that the orthopedic doctors pay more attention to the prevention of VTE year by year.