住院患者静脉血栓栓塞症发病率及相关危险因素分析

Incidence of venous thrombosis and analysis of the related risk factors in hospitalized patients

目的探讨住院患者静脉血栓栓塞、肺栓塞发病率、抗凝药物使用率及变化趋势。方法通过湖南省人民医院大数据系统回顾2016年01月至2022年12月不同性别、年龄、基础疾病住院患者静脉血栓栓塞症(VTE)、肺血栓栓塞(PE)发病人数,抗凝药物使用人数,比较各种因素对VTE、PE发病率及风险比(RR)的影响。结果2016年至2022年出院总人次941695人。总VTE、PE发病率分别为1.18%和0.20%;从2016年的0.23%和0.03%,升高到2022年的2.51%和0.30%(P<0.001);男性患者分别为1.25%和0.24%,高于女性患者的1.1%和0.17%(P<0.001)。合并VTE、PE的患者死亡率高于总体住院患者(P<0.001)。VTE发病率最高的基础疾病依次为脊髓损伤17.57%,严重感染(脓毒症13.96%,重症肺炎12.76%,血流感染13.31%),急性呼吸窘迫综合征(ARDS)12.8%,股骨、髋部骨折10.91%、10.33%,休克9.91%,脑出血8.90%(与总VTE发病率比较,P<0.001)。预防性抗凝使用率逐年提高,与基础疾病VTE、PE发病率正相关(P<0.001)。结论住院患者预防性抗凝率逐年提高,但VTE、PE发病率仍在升高。脊髓损伤、严重感染、ARDS、下肢骨折、休克、脑出血等疾病VTE、PE发病率居高不下,需高度重视,加强防控。

Objective To investigate the incidence of venous thromboembolism(VTE),pulmonary embolism(PE)and the proportion of anticoagulant treatment,and their trends in hospitalized patients.Method The Big Data Retrieval System of Hunan Provincial People's Hospital was used to review the incidence of venous thromboembolism(VTE)and pulmonaryo embolism(PE),as well as the number of anticoagulant users in hospitalized patients of different gender,age,and underlying diseases from January 2016 to December 2022,and to compare the effects of various factors on the incidence and the risk ratio(RR)of VTE and PE.Results From 2016 to 2022,the total number of discharged patients was 941695,including 495653 males and 437052 females.The overall incidence of VTE and PE were 1.18%and 0.20%,respectively;they increased from 0.23% and 0.03% in 2016 to 2.51% and 0.30% in 2022(P<0.001).The incidence of VTE and PE in male patients were 1.25% and 0.24%,respectively,which was higher than 1.1% and 0.17% in female patients(P<0.001).The mortality among patients with VTE and PE was higher than that of the overall inpatients(P<0.001).The anticoagulant rate was positively correlated with the incidence of VTE and PE in patients with different diseases.The mortality of patients with VTE and PE was higher than that of all hospitalized patients(P<0.001).The diseases with the highest incidence of VTE were spinal cord injury(17.57%),severe infections(sepsis 13.96%,severe pneumonia 12.76%,bloodstream infection 13.31%),acute respiratory distress syndrome(12.8%),femoral and hip fractures(10.91% and 10.33% respectively),shock(9.91%),and intracranial hemorrhage(8.90%)(when compared with the overall VTE incidence,all P<0.001).The overall anticoagulant rate increased year by year and was positively correlated with the incidence of VTE and PE in patients with underlying diseases(P<0.001).Conclusions The rate of prophylactic anticoagulation in hospitalized patients has increased year by year,but the incidence of VTE and PE is still increasing.Some diseases such as spinal cord injury,severe infections,ARDS,lower limb fractures,shock,and intracranial hemorrhage,etc.were associated with persistently high incidences of VTE and PE.Greater emphasis should be placed on prophylaxis and control in these patients.