Padua评分和IMPROVE bleeding RAM联合应用预测重症患者发生静脉血栓栓塞症的价值分析

The Value Analysis of the Combination of Padua Score and IMPROVE Bleeding RAM in predicting the Occurrence of venous Thromboembolism in critically Patients

目的分析Padua评分联合国际医学预防注册中心静脉血栓栓塞出血风险评估模型(IMPROVE bleeding RAM)在预测重症患者发生静脉血栓栓塞症(VTE)中的应用价值。方法将河南科技大学附属许昌市中心医院2020年5月至2022年5月SICU62例作为此次研究对象,按随机数字表法划分组别(分为病例组与对照组,各31例)。根据Padua评分和IMPROVE bleeding RAM评估患者VTE发生风险,病例组在Padua评分和IMPROVE bleeding RAM指导下给予综合治疗干预(抗凝药物+物理疗法等),对照组采取常规治疗干预(常规药物),对比两组VTE发生率。另外再根据是否发生VTE将62例患者分为VTE发生组(8例),VTE未发生组(54例),用Logistic回归方程进行计算,分析VTE发病相关因素,分析静脉血栓栓塞症发生风险与Padua、IMPROVE bleeding RAM评分的相关性。结果病例组VTE发生率(3.23%)低于对照组(22.58%),差异有统计学意义(P<0.05);将Padua评分、IMPROVE bleeding RAM带入Logistic回归方程计算发现Padua评分<4分、IMPROVE bleeding RAM<7分均是VTE发生的影响因素,95%可信区间(CI)分别为-0.071~4.888、-0.181~5.825,差异有统计学意义(P<0.001);静脉血栓栓塞症发生风险与Padua、IMPROVE bleeding RAM评分均呈正相关,差异有统计学意义(P<0.005)。结论对重症患者实施Padua评分联合IMPROVE bleeding RAM评估能准确判断VTE,可作为后续静脉血栓栓塞症预防性治疗的参考依据,同时以此为依据进行对症治疗干预,可有效预防VTE发生。

Objective To analyze the application value of the Padua score combined with the International Medical Prevention Registry Venous Thromboembolism Bleeding Risk Assessment Model(IMPROVE bleeding RAM)in predicting the occurrence of venous thromboembolism(VTE)in critically patients.Methods A total of 62 SICU patients from Xuchang Central Hospital Affiliated to Henan University of Science and Technology from May 2020 to May 2022 were selected as the study subjects.They were divided into a case group and a control group using a random number table method,with 31 patients in each group.According to the Padua score and IMPROVE bleeding RAM,patients were evaluated for the risk of VTE.The case group received comprehensive treatment interventions(anticoagulants+physical therapy,etc.)under the guidance of the Padua score and IMPROVE bleeding RAM,while the control group received conventional treatment interventions(conventional drugs).The incidence of VTE was compared between the two groups.In addition,62 patients were divided into VTE occurrence group(32 cases)and VTE non-occurrence group(30 cases)based on the occurrence of VTE.Logistic regression equations were used to calculate and analyze the factors related to VTE incidence,as well as the correlation between the risk of venous thromboembolism and Padua and IMPROVE bleeding RAM scores.Results The incidence of VTE in the case group(3.23%)was lower than that in the control group(22.58%),with a statistically significant difference(P<0.05);Introducing the Padua score and IMPROVE bleeding RAM into the logistic regression equation,it was found that Padua score<4 and IMPROVE bleeding RAM<7 were all influencing factors for the occurrence of VTE,with 95%confidence intervals(CI)of-0.071~4.888 and-0.181~5.825,respectively,with statistically significant differences(P<0.001);The risk of venous thromboembolism was positively correlated with Padua and IMPROVE bleeding RAM scores,and the difference was statistically significant(P<0.05).Conclusion The combination of Padua score and IMPROVE bleeding RAM assessment can accurately determine VTE in critically ill patients,and can serve as a reference for subsequent preventive treatment of venous thromboembolism.At the same time,targeted treatment interventions based on this can effectively prevent the occurrence of VTE.