医院相关性静脉血栓栓塞症的临床特征及相关危险因素分析  

Risk factors and clinical features of hospital-associated venous thromboembolism

作　　者：邵翔[1] 司超增[2] 甄凯元 张竹 王静 王丁一 雷洁萍 万钧[7] 谢万木[7] 翟振国[7] 王辰[4] Shao Xiang;Si Chaozeng;Zhen Kaiyuan;Zhang Zhu;Wang Jing;Wang Dingyi;Lei Jieping;Wan Jun;Xie Wanmu;Zhai Zhenguo;Wang Chen(China-Japan Friendship Clinical Medical College,Beijing University of Chinese Medicine,Beijing 100029,China;Information Center,China-Japan Friendship Hospital,Beijing 100029,China;Institute of Clinical Medical Sciences,China-Japan Friendship Hospital,Beijing 100029,China;Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pulmonary and Critical Care Medicine Center of Respiratory Medicine,Beijing Hospital,Beijing 100730,China;Data and Project Management Unit,Institute of Clinical Medical Sciences,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine Center of Respiratory Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中医药大学中日友好临床医学院,北京100029 [2]中日友好医院信息中心,北京100029 [3]中日友好医院临床研究所,北京100029 [4]中国医学科学院北京协和医学院,北京100730 [5]北京医院呼吸与危重症医学科,北京100730 [6]中日友好医院临床研究所临床研究数据与项目管理平台,北京100029 [7]中日友好医院呼吸中心呼吸与危重症医学科,北京100029

出　　处：《中华医学杂志》2020年第20期1539-1543,共5页National Medical Journal of China

基　　金：国家重点研发计划(2016YFC0905600);国家自然科学基金面上项目(81570049,81970058)。

摘　　要：目的:探讨医院相关性静脉血栓栓塞症(VTE)的临床特征及相关危险因素。方法:入选2017年1月1日至12月31日在中日友好医院住院确诊为急性VTE的患者。根据患者VTE事件是否发生在住院期间或发生VTE前90 d内是否有住院经历(内科患者住院超过2 d或外科患者在麻醉下进行手术)分为医院相关性VTE组(HA-VTE组)和社区相关性VTE组(CA-VTE组)。比较两组之间基线资料、临床表现、危险因素、结局事件之间的差异。结果:本研究共纳入437例急性VTE患者,HA-VTE组266例,CA-VTE组171例。在危险因素方面,CA-VTE组更多合并静脉曲张、久坐、长途旅行,HA-VTE组更多合并近期手术(<1个月)、卧床、活动性恶性肿瘤、肺部感染、急性脑梗死、骨折、中心静脉置管等危险因素(均P<0.05)。CA-VTE组患者下肢疼痛、呼吸困难、胸痛、胸闷等临床症状均显著高于HA-VTE组(均P<0.05),HA-VTE组患者合并较少临床症状但猝死比例更高(0比3.4%,P=0.035)。在HA-VTE患者中,有92.8%的患者VTE发生在住院期间及出院后1个月内,中位时间为13 d。在全因死亡率方面,HA-VTE组高于CA-VTE组(8.3%比1.2%,P<0.001),其中住院期间发生VTE的患者高于出院后90 d内发生VTE的患者(12.2%比3.4%,P<0.001)。结论:超过半数VTE事件的发生与近期住院经历相关。与CA-VTE相比,HA-VTE的常见危险因素不同、合并较少临床症状但全因死亡率更高。应增加对于住院患者VTE的关注,减少HA-VTE事件的发生。Objective To investigate the clinical features and risk factors of hospital-associated venous thromboembolism(VTE).Methods The study enrolled acute VTE patients admitted into China-Japan Friendship Hospital from January 1,2017 to December 31,2017.The hospital-associated VTE(HA-VTE)group and the community-associated VTE(CA-VTE)group were classified according to whether the VTE occurred during hospitalization or within a 90-day period of admission to hospital(including inpatient with at least two days of hospital stay or a surgical procedure under general or regional anaesthesia).Differences in clinical features,risk factors,and mortality rate were compared between the two groups.Results A total of 437 patients with acute VTE were analyzed in the study.Among them,266 patients were HA-VTE,171 patients were CA-VTE.Patients in the CA-VTE group were more likely to have varicose veins,sedentary,long-distance travel,and patients in the HA-VTE group were more complicated with recent surgery(<1 month),bed rest,active malignant tumor,acute infections,acute cerebral infarction,fracture,central venous catheter(P<0.05).The CA-VTE group had more clinical symptoms such as lower extremity pain,dyspnea,chest pain and chest tightness(P<0.05).HA-VTE patients had less clinical symptoms but were more severe than the CA-VTE patients,with more sudden deaths(0 vs 3.4%,P=0.035).Among HA-VTE patients,92.8%experienced VTE during hospitalization or within 1 month of the preceding hospital encounter,with a 13-day median time to VTE.The all-cause mortality rate was higher for HA-VTE group than CA-VTE group(8.3%vs 1.2%,P<0.001),and the in-hospital VTE was more common compared to VTE diagnosed post-discharge(12.2%vs 3.4%,P<0.001).Conclusions More than half events of VTE are related to recent hospitalizations.HA-VTE has different risk factors from CA-VTE,combined with fewer clinical symptoms but higher all-cause mortality rate.More attention about VTE should be paid to hospitalized patients to reduce the incidence of HA-VTE events.

关 键 词：静脉血栓形成 住院 疾病特征 危险因素 

分 类 号：R54[医药卫生—心血管疾病]