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中华脑血管病杂志(电子版)

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
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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]. 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]. 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。

关键词: 妇科手术, 危险因素, 风险预测模型, 静脉血栓栓塞
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.

Key words: Gynecological surgery, Risk factors, Risk model analysis, Venous thromboembolic disease
表1 妇科手术患者发生VTE单因素分析（例）
风险因素 调查例数 VTE例数 VTE发生率（%） χ2值 P值
年龄（岁） 56.597 ＜0.001
＜50 178 11 6.18
≥50 107 46 42.99
BMI（kg/m2） 7.815 0.020
＜25 185 28 15.14
25~28 80 23 28.75
＞28 20 6 30.00
静脉曲张 34.476 ＜0.001
否 264 42 15.91
有 21 15 71.43
肿瘤性质 20.201 ＜0.001
良性 174 20 11.49
恶性 111 37 33.33
手术方式 10.357 0.001
腹腔镜 236 39 16.53
开腹 49 18 36.73
输血 25.404 ＜0.001
否 259 42 16.22
是 26 15 57.69
手术时间≥3 h 30.202 ＜0.001
否 192 21 10.94
是 93 36 38.71
术后卧床时间≥48 h 75.497 ＜0.001
否 241 27 11.20
是 44 30 68.18
内科合并症 1.892 0.595
高血压 31 9 29.03
糖尿病 18 3 16.67
其他 9 2 22.22
无合并症 227 43 18.94
术中出血量（ml） 27.837 ＜0.001
＜500 252 39 15.48
≥500 33 18 54.55
表2 妇科手术患者发生VTE多因素Logistic回归分析
变量 β值 SE值 Wald χ2值 OR值 95%CI P值
静脉曲张 1.416 0.617 5.263 4.121 1.229~13.815 0.020
术后卧床时间≥48 h 2.175 0.523 17.321 8.804 3.161~24.525 ＜0.001
手术时间≥3 h 1.205 0.437 7.608 3.337 1.417~7.857 0.006
恶性肿瘤 1.072 0.496 4.681 2.922 1.106~7.716 0.030
年龄≥50岁 2.027 0.456 19.776 7.590 3.106~18.535 ＜0.001
开腹手术 0.037 0.523 0.005 1.038 0.373~2.891 0.944
出血量≥500 ml -0.620 0.810 0.586 0.538 0.110~2.632 0.939
输血 1.314 0.809 2.636 3.721 0.762~18.177 0.104
BMI＞28 kg/m2 -0.190 0.743 0.065 0.827 0.193~3.549 0.798
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
风险值 例数 静脉血栓栓塞[例（%）] β值 SE值 Wald χ2值 OR值 95%CI P值
0 89 1（1.12） 1
1 69 6（8.70） 1.421 0.833 2.911 4.143 0.809~21.204 0.088
2 62 11（17.74） 2.239 0.789 8.058 9.382 2.000~44.018 0.005
≥3 65 39（60.00） 4.178 0.759 30.330 65.250 14.750~288.650 ＜0.001
P值 ＜0.001
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