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中华脑血管病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 332 -337. doi: 10.11817/j.issn.1673-9248.2022.05.008

论著

妇科手术后静脉血栓栓塞的风险预测模型分析
陈偲1, 罗喜平1, 孙小丽1, 文斌1,()   
  1. 1. 511400 广州,广东省妇幼保健院番寓院区妇科
  • 收稿日期:2021-12-29 出版日期:2022-10-01
  • 通信作者: 文斌

Risk model of venous thromboembolism after gynecological surgery

Cai Chen1, Xiping Luo1, Xiaoli Sun1, Bin Wen1,()   

  1. 1. Department of Gynaecology, Guangdong Women's and Children's Hospital, Guangzhou 511400, China
  • Received:2021-12-29 Published:2022-10-01
  • Corresponding author: Bin Wen
引用本文:

陈偲, 罗喜平, 孙小丽, 文斌. 妇科手术后静脉血栓栓塞的风险预测模型分析[J/OL]. 中华脑血管病杂志(电子版), 2022, 16(05): 332-337.

Cai Chen, Xiping Luo, Xiaoli Sun, Bin Wen. Risk model of venous thromboembolism after gynecological surgery[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(05): 332-337.

目的

探讨妇科手术后患者并发静脉血栓栓塞(VTE)的危险因素,并建立相应的风险预测模型。

方法

选择广东省妇幼保健院番禺院区2017年3月至2020年10月收治的妇科手术后并发VTE的患者57例,对照组选择同期行妇科手术非VTE的妇科肿瘤患者228例。对患者年龄、体质量指数(BMI)、肿瘤性质、静脉曲张、内科合并症、手术方式、手术时间、术中出血量、术后卧床时间等资料进行单因素和多因素Logistic回归分析,归纳妇科手术后并发VTE的危险因素,并建立VTE预测风险模型。

结果

单因素分析显示不同年龄、BMI、肿瘤性质、手术时长、术中出血量、有无输血、卧床时间、静脉曲张等方面差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥50岁(OR=7.590,P<0.001)、恶性肿瘤(OR=2.922,P=0.030)、手术时间≥3 h(OR=3.337,P=0.006)、静脉曲张(OR=4.121,P=0.020)、术后卧床时间≥48 h(OR=8.804,P<0.001)是妇科手术患者并发VTE的独立危险因素。根据5个独立危险因素建立VTE预测模型,无危险因素患者发生VTE为低风险,有1个或2个危险因素为中危风险,≥3个危险因素为高危风险。

结论

年龄大、恶性肿瘤、手术时间长、静脉曲张、卧床时间长患者妇科手术后更易发生VTE。对于中高危风险患者,应给予适当的干预措施,建议1周内行超声检查。

Objective

To explore the risk factors of venous thromboembolism (VTE) in patients after gynecological surgery.

Methods

A total of 57 patients with VTE after gynecological surgery admitted to Panyu Hospital of Guangdong Maternal and Child Health Hospital from March 2017 to October 2020 were included as the observation group. A total of 228 patients with non-VTE gynecological tumors from 4 adjacent gynecological operations were included as the control group. Univariate and multivariate analyses were performed in patients' age, body mass index (BMI), tumor nature, varicose veins, medical complications, operation method, operation time, blood loss, postoperative bed time. The risk factors of VTE after gynecological surgery were summarized and a predictive risk model for VTE was established.

Results

In univariate analysis, the two groups had statistically significant differences in age, BMI, nature of the tumor, length of operation, blood loss, presence or absence of blood transfusion, time in bed, and varicose veins (P<0.05). Multivariate logistic regression showed that age≥50 years old (OR=7.590, P<0.001), malignant tumor (OR=2.922,P=0.030), operation duration≥3 h (OR=3.337, P=0.006), varicose veins (OR=4.121, P=0.020), bedtime≥48 h (OR=8.804, P<0.001) were independent risk factors that affected patients with gynecological surgery complicated with VTE. A VTE prediction model was established based on 5 independent risk factors. Patients without risk factors were at low risk of VTE, with 1 or 2 risk factors were at intermediate risk, and ≥3 risk factors high risk.

Conclusion

Patients with older age, malignant tumors, long operation time, varicose veins, and long bedtime were more likely to develop VTE after gynecological surgery. For patients with medium and high-risk factors, appropriate interventions should be given.

表1 妇科手术患者发生VTE单因素分析(例)
表2 妇科手术患者发生VTE多因素Logistic回归分析
图1 回归模型预测妇科手术患者发生VTE风险的受试者操作特征曲线
表3 基于5个独立危险因素联合模式的静脉血栓栓塞预测模型
1
Qu H, Li Z, Zhai ZG, et al. Predicting of venous thromboembolism for patients undergoing gynecological surgery [J]. Medicine (Baltimore), 2015, 94(39): e1653.
2
Nicolaides AN, Breddin HK, Kakkar AK, et al. Prevention of venous thromboembolism. International Consensus Statement [J]. Int Angiol, 2013, 32(2): 111-260.
3
Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J]. Chest, 2012, 141(2 Suppl): e351S-e418S.
4
Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer [J]. Thromb Haemost, 2000, 83(3): 416-420.
5
Caprini JA. Thrombosis risk assessment as a guide to quality patient care [J]. Dis Mon, 2005, 51(2-3): 70-78.
6
郎景和, 王辰, 瞿红, 等. 妇科手术后深静脉血栓形成及肺栓塞预防专家共识 [J]. 中华妇产科杂志, 2017, 52(10): 649-653.
7
蒋志峰, 赵仁峰. 妇科手术后患者并发静脉血栓栓塞症的危险因素分析 [J]. 广西医学, 2020, 42(11): 1351-1353.
8
赵姝. 妇科盆腔手术并发静脉血栓栓塞症的相关因素分析 [D]. 银川: 宁夏医科大学, 2016.
9
刘胜楠, 陆胜莲, 顾仲毅, 等. 妇科恶性肿瘤手术患者静脉血栓栓塞症危险因素分析及风险评估表的应用 [J]. 第二军医大学学报, 2017, 38(10): 1244-1249.
10
杨婷, 田思娟, 赵娟, 等. 妇科手术患者静脉血栓栓塞症的危险因素评估和评分简表的有效性验证 [J]. 实用妇产科杂志, 2019, 35(5): 368-371.
11
陈志波, 陈钦昌, 李勇辉, 等. 身体质量指数与深静脉血栓形成因果关系的孟德尔随机化研究 [J]. 中华血管外科杂志, 2019, 4(4): 247-251.
12
Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis [J]. Blood, 2008, 111(10): 4902-4907.
13
Nick AM, Schmeler KM, Frumovitz MM, et al. Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery [J]. Obstet Gynecol, 2010, 116(4): 956-961.
14
王桂云, 李曼, 王海波. 妇科手术后并发静脉血栓临床特征及相关因素分析 [J]. 创伤与急危重病医学, 2019, 7(1): 49-51.
15
赵成华, 孙超. 妇科盆腔手术后下肢静脉血栓的预防性护理 [J]. 医学理论与实践, 2006, 19(1): 89-90.
16
季洪良, 任婧, 郑洋洋, 等. 凝血酶-抗凝血酶复合物和D-二聚体在妇科手术患者术后静脉血栓栓塞症中的监测价值 [J]. 世界最新医学信息文摘, 2018, 18(80): 184-188.
17
郄明蓉, 段瑞岐. 妇科术后患者发生静脉血栓的发病原因分析及防治 [J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(6): 723-727.
18
Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy [J]. Chest, 2004, 126(3 Suppl): 338S-400S.
19
Stein PD, Hull RD, Kayali F, et al. Venous thromboembolism according to age: the impact of an aging population [J]. Arch Intern Med, 2004, 164(20): 2260-2265.
20
Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management [J]. J Thromb Thrombolysis, 2006, 21(1): 23-29.
21
De Stefano F, Zambon S, Giacometti L, et al. Obesity, Muscular strength, muscle composition and physical performance in an elderly population [J]. J Nutr Health Aging, 2015, 19(7): 785-791.
22
张营, 汪颖厚, 曹宇, 等. 不同年龄、季节对下肢深静脉血栓形成发病影响研究 [J]. 临床军医杂志, 2018, 46(11): 1385.
23
Clarke-Pearson DL, DeLong ER, Synan IS, et al. Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model [J]. Obstet Gynecol, 1987, 69(2): 146-150.
24
段洁, 熊俊, 邹倩, 等. 妇科盆腔手术后深静脉血栓形成11例分析 [J]. 武汉大学学报(医学版), 2010, 31(2): 246-248.
25
Fimognari FL, Repetto L, Moro L, et al. Age, cancer and the risk of venous thromboembolism [J]. Crit Rev Oncol Hematol, 2005, 55(3): 207-212.
26
Clarke-Pearson DL, Jelovsek FR, Creasman WT. Thromboembolism complicating surgery for cervical and uterine malignancy: incidence, risk factors, and prophylaxis [J]. Obstet Gynecol, 1983, 61(1): 87-94.
27
Bakhru A. Effect of ovarian tumor characteristics on venous thromboembolic risk [J]. J Gynecol Oncol, 2013, 24(1): 52-58.
28
Sweetland S, Green J, Liu B, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study [J]. BMJ, 2009, 339: b4583.
29
Peedicayil A, Weaver A, Li X, et al. Incidence and timing of venous thromboembolism after surgery for gynecological cancer [J]. Gynecol Oncol, 2011, 121(1): 64-69.
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