重症患者静脉血栓栓塞风险和预防的回顾性分析  

A retrospective analysis of venous thromboembolism risk and prevention in critically ill patients

作　　者：张惠[1] 马渝[1] 文玉明[1] 鲁力[1] 

机构地区：[1]重庆市急救医疗中心、重庆市第四人民医院重庆市急救医学研究所重症医学部,重庆400014

出　　处：《中华急诊医学杂志》2013年第5期517-520,共4页Chinese Journal of Emergency Medicine

摘　　要：目的评估重庆市急救医疗中心ICU重症患者静脉血栓栓塞（VTE）风险和预防措施的临床现况，探讨重症患者预防VTE的合理策略。方法回顾性分析本中心ICU2010年12月至2012年1月共276例ICU治疗时间超过48h病例。通过简化Caprini评分评估入ICU当天和第7天重症患者VTE风险及内科、外科、创伤亚组重症患者VTE风险。分析重症患者VTE风险与年龄、性别、GCS及APACHE[[评分等临床指标的关系；分析具有VTE非低危风险的重症患者采取相应预防措施的情况及其原因。结果本中心ICU重症患者入ICU当天和第7天的简化Caprini评分分别为（8．71±4．90）和（9．24±5．30），简化Caprini评分与APACHEll呈显著正相关（r=0．397，P=0．027）。超过90％重症患者是VTE的高危和极高危人群，外科及创伤的重症患者简化Caprini评分明显高于内科重症患者（14．02±2．01），（14．5±1．29）VS．（6．55±3．98），P〈0．01。在VTE高危患者中，早期（48h内）采取预防措施的只有18．28％（机械预防13．43％，药物预防5．22％），即使在7d后也仅有25．83％（机械预防11．92％，药物预防16．56％）。结论重症患者是院内VTE的极高危人群，VTE风险与重症患者病情密切相关，VTE风险可能贯穿ICU治疗过程始终，故应将动态VTE风险及出血风险评价纳入重症患者的常规评估项目，制定合理的VTE预防策略。Objective To estimate the venous thromboembolism （VTE） risk and prevention in critically ill patients admitted to ICU and discuss the appropriate strategy for prevention. Methods A total of 276 critically ill patients staying longer than 48 hours in ICU were enrolled for a retrospective single-center study. VTE risk assessment, methods for mechanical and pharmacological prophylaxis and demographic data were recorded. Simplified Caprini scores for VTE risk were counted in the first day and 7th day after admission to ICU, and were compared among internal medicine, surgery and trauma subgroups. Relationship between VTE risk and the clinic index was analyzed by Pearson test and Spearman test with SPSS 17.0 software. The prophylaxis strategy applied to patients without low risk of VTE was explored. Results Simplified Caprini scores were （8.71±4. 90） and （9.24±5.30） on the first day and the 7th day after admission respectively. Simplified Caprini score was significantly related to APACHE II score （ r = 0. 397, P = 0. 027）. Meanwhile, simplified Caprini score in surgical and traumatic patients was higher than that in medical ill patients （ 14. 02 ± 2. 01 ）, （ 14. 5 ±1.29） vs. （6. 55±3.98）, P 〈 0. 01. The total rate of early prophylaxis measures used with mechanical prevention （13.43%） and pharmacological prophylaxis （5.22%） was only 18.28% within 48 hours after admissioin of patients with highest riskof VTE. Even on the 7th day after admission to ICU, the total rate of prophylaxis measure employed with mechanical prevention （ 11.92% ） and phatanacological prophylaxis （ 11.56% ） for VTE was 25.83%. Conclusions Critically ill patients in ICU were subjected to extremely high risk of VTE. The VTE risk related closely to the severity of critically illness existed throughout the whole period of the ICU stay. Constant assessment forVTE risk and bleeding risk should be made with frequent assessment for critically ill patients.

关 键 词：静脉血栓栓塞 深静脉血栓 肺栓塞 重症患者 抗凝治疗 

分 类 号：R45[医药卫生—治疗学]