不同科室新发静脉血栓栓塞症患者防治现状与对策分析

Current situation and countermeasures of prevention and treatment of new venous thromboembolism patients in different departments

目的 利用根因分析法分析不同科室新发静脉血栓栓塞症(venous thromboembolism,VTE)患者的防治现状,为医院VTE患者的临床流程管理和完善提供政策建议及数据支持。方法 纳入2019年3月至2020年3月北京世纪坛医院院内新发VTE患者993例,分析患者的基本情况、风险评估分层、防治措施等。结果 内外科新发VTE患者以高危及极高危为主,高龄、肿瘤、手术为患者新发VTE的前三位危险因素,患者在动态风险评估、出血风险评估、专科会诊、物理预防、主动预防、治疗规范等方面均不理想,内外科患者在基本住院信息、血栓风险分层、危险因素、临床检查与诊断、预防与治疗多个方面的差异具有统计学意义(P<0.05,P<0.01)。结论 高龄、手术、肿瘤患者仍是VTE防治的重点人群,VTE出血及动态风险评估不容忽视,完善VTE相关检查流程、关注主动预防、提升治疗规范化,依据不同科室特点实行差异化防治管理值得思索。

Objective To analyze the prevention and treatment status of new venous thromboembolism(VTE) patients in different departments by root cause analysis,and provide policy suggestions and data support for the clinical process management of VTE patients.Methods A total of 993 new VTE patients in Beijing Shijitan Hospital from March 2019 to March 2020 were included,and their basic conditions,risk assessment stratification,prevention and treatment measures were analyzed.Results The new VTE patients in internal medicine department and surgery department were mainly at high-risk and extremely high-risk.The elderly,tumor and operation were the top three risk factors for new VET in the patients.The patients were not ideal in dynamic risk assessment,bleeding risk assessment,specialist consultation,physical prevention,active prevention and treatment specifications etc.There were significant differences in basic hospitalization information,thrombosis risk stratification,risk factors,clinical examination and diagnosis,prevention and treatment between patients in internal medicine department and surgery department(P<0.05,P<0.01).Conclusion The patients with elderly,surgery,and tumor patients are still the key populations for VTE prevention and treatment.The dynamic and bleeding risk assessment in VTE should not be ignored.It is worth thinking about improving the VTE-related examination process,focusing on active prevention,improving the standardization of treatment,and implementing differential prevention and treatment management according to the characteristics of different departments.