| 摘要: |
| 目的 探讨妇科恶性肿瘤手术患者并发静脉血栓栓塞症（VTE）的危险因素，并评价《住院患者静脉血栓栓塞症风险评估表》在妇科恶性肿瘤手术并发VTE患者中的应用价值。方法 选取我院2010年10月至2015年11月期间收治的妇科恶性肿瘤手术患者530例，其中确诊并发VTE者58例，未并发VTE者472例，根据患者年龄、体质量指数（BMI）、肿瘤类型、肿瘤分期、手术方式、手术时长、出血量、有无输血、卧床时间、有无合并症等因素进行统计学分析。应用我院多学科联合制定的新版《住院患者静脉血栓栓塞症风险评估表》对2015年11月至2017年4月收治的317例妇科恶性肿瘤手术患者进行围手术期的动态评估，根据评估结果采取针对性的干预措施，统计VTE的发生率并与未应用评估表的患者进行比较。结果 单因素分析结果显示，妇科恶性肿瘤手术患者并发VTE与BMI、肿瘤分期、手术时长、出血量、有无输血、卧床时间有关（P<0.05）；多因素分析结果显示，年龄、BMI、肿瘤分期、手术时长、手术方式是影响妇科恶性肿瘤手术患者并发VTE的独立危险因素（P<0.05）。应用新版《住院患者静脉血栓栓塞症风险评估表》进行评估并采取针对性措施后，VTE的发生率低于应用前[1.89%（6/317）vs 10.9%（58/530）]，差异具有统计学意义（P<0.05）。结论 年龄、BMI、肿瘤分期、手术时长、手术方式是影响妇科恶性肿瘤手术患者并发VTE的独立危险因素。通过在围手术期有效评估VTE发生风险，根据风险评分采取相应有效预防措施，可降低妇科恶性肿瘤手术患者VTE的发生率。 |
| 关键词: 静脉血栓栓塞 女性生殖器肿瘤 妇科外科手术 围手术期 危险因素 |
| DOI：10.16781/j.0258-879x.2017.10.1244 |
| 投稿时间：2017-07-04修订日期：2017-09-13 |
| 基金项目: |
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| Risk factors analysis of venous thromboembolism in post-operative patients with gynecological malignant tumor and application of related risk assessment table |
| LIU Sheng-nan△,LU Sheng-lian△,GU Zhong-yi,LI Li,TANG Chun-tao,ZHANG Jun-jie* |
(Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the risk factors of venous thromboembolism (VTE) in post-operative patients with gynecological malignant tumors, and to evaluate the value of Risk Assessment Table of VTE in Hospitalized Patients in above patients. Methods A total of 530 post-operative patients with gynecological malignant tumors in our hospital between Oct. 2010 and Nov. 2015 were enrolled, including 58 cases complicated with VTE and 472 cases without VTE. Clinical indexes of all patients including age, body mass index (BMI), tumor type, tumor stage, operation method, operation time, amount of bleeding, history of blood transfusion, bedridden time, and history of comorbidities were statistically analyzed. The clinical dynamic evaluation of 317 post-operative patients with gynecological malignant tumor diagnosed between Nov. 2015 and Apr. 2017 were conducted by the new version of Risk Assessment Table of VTE in Hospitalized Patients, which was jointly developed by our hospital. Targeted interventions were used based on the evaluation results, and the incidence of VTE was observed and compared with patients who did not use the assessment table. Results Univariate analysis results showed that BMI, tumor stage, operation time, amount of bleeding, blood transfusion and bedridden time were significantly related to VTE (P<0.05). Multivariate analysis results showed that age, BMI, tumor stage, operation time and operation method were independent risk factors of VTE in post-operative patients with gynecological malignant tumor (P<0.05). After application of the Risk Assessment Table of VTE in Hospitalized Patients and taking corresponding interventions, the incidence of VTE in patients was significantly lower than that before application (1.89%[6/317] vs 10.9%[58/530], P<0.05). Conclusion Age, BMI, tumor stage, operation time and operation method are the independent risk factors of VTE in post-operative patients with gynecological malignant tumor. Assessing the risk of VTE in the peri-operative period and taking appropriate preventive measures according to the risk score can reduce the incidence of VTE in post-operative patients with gynecological malignancies. |
| Key words: venous thromboembolism female genital neoplasms gynecologic procedures intraoperative period risk factors |
