肺外科术后静脉血栓栓塞症预防性抗凝现状分析:单中心研究结果  

Analysis of current status of prophylactic anticoagulation in patients with venous thromboembolism after lung surgery:a single center study

作　　者：崔松平 田博 李辉[1] 宋春凤[1] 胡滨[1] Cui Songping;Tian Bo;Li Hui;Song Chunfeng;Hu Bin(Department of Thoracic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Thoracic Surgery,Sichuan Cancer Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,China)

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,100020 [2]电子科技大学医学院附属四川省肿瘤医院胸外科,成都610041

出　　处：《中华胸心血管外科杂志》2020年第11期678-681,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨肺外科术后静脉血栓栓塞症(venous thromboembolism,VTE)的发生特点以及预防性抗凝药物应用情况。方法选取2016年7月至2017年12月接受肺手术的患者,回顾性总结其临床资料。纳入标准:(1)原发性肺部疾病;(2)接受肺手术治疗;(3)手术前后均行下肢静脉多普勒超声检查。结果共659例患者入选,术后58例发生VTE,发病率为8.8%。151例患者应用预防性抗凝药物,总预防用药率为22.9%(151/659)。按改良Caprini风险评估量表将入组患者分为:低危组(≤4分)300例,中危组(5~8分)328例,高危组(≥9分)31例;其预防性抗凝比例分别为4.0%(12/300),36.3%(119/328)和64.5%(20/31)。预防性抗凝用药的时长也差异较大,抗凝1~3天99例,4~6天46例,7~9天6例。各组内接受预防性抗凝的患者与未接受预防性抗凝的患者VTE发生率差异均无统计学意义(P>0.05)。结论肺外科术后VTE发病率较高,但患者接受预防性抗凝比例较低,且抗凝疗程过短不符合用药规范,因此造成了预防效果不理想。提示今后应规范应用抗凝药以达到预防血栓发生的目的。Objective To identify the characteristics of venous thromboembolism(VTE)after lung surgery and the use of prophylactic anticoagulants.Inclusion criteria:(1)patients with primary pulmonary disease;(2)received pulmonary surgery;(3)Doppler ultrasound examination of lower extremity veins before and after operation.Methods Patients who underwent lung surgery in our department from July 2016 to December 2017 were studied retrospectively.Results A total of 659 patients who underwent lung surgery were analyzed,of which 58 patients had new diagnosis of VTE,after surgery with an incidence of 8.8%,and 151 patients were treated with prophylactic anticoagulants,with a total prophylactic use rate of 22.9%.According to the modified Caprini risk assessment scale,the patients were divided into three groups:low risk group(≤4 points),medium risk group(5-8 points)and high risk group(≥9 points).The proportion of prophylactic anticoagulation in each group was 4.0%(12/300),36.3%(119/328)and 64.5%(20/31),respectively.The duration of prophylactic anticoagulation was also quite different,including 99 patients with anticoagulation for 1-3 days,46 for 4-6 days,and 6 for 7-9 days.There was no significant difference in the incidence of VTE between patients who received prophylactic anticoagulation and patients who did not receive prophylactic anticoagulation(P>0.05).Conclusion The incidence of VTE after pulmonary surgery is high,but the proportion of patients receiving prophylactic anticoagulation is low,and the anticoagulation course is too short,which leads to the poor preventive effect.It is suggested that the use of anticoagulants should be reasonably standardized in the future in order to improve the state of blood coagulation and prevent thrombosis.

关 键 词：静脉血栓栓塞症 肺术后 预防性抗凝 合理用药 

分 类 号：R655.3[医药卫生—外科学]