胸外科术后肺栓塞发生与预防性抗凝1500例分析  

A retrospective study on pulmonary embolism incidence and thromboprophylaxis after thoracic surgery among 1500 patients

作　　者：沈蕾[1] 李玉萍[1] 丁君蓉[1] 杨健[1] 姜格宁[1] Shen Lei;Li Yuping;Ding Junrong;Yang Jian;Jiang Gening(Department of Thoracic ICU,Tongji University Affiliated Shanghai Pulmonary Hospital,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科ICU,200433

出　　处：《中华胸心血管外科杂志》2020年第11期682-685,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评估依据Caprini量表进行预防性药物抗凝在胸外科预防术后肺栓塞中的作用。方法选取2015~2017每年6月1日开始的连续手术病例各500例,共计1500例。记录患者一般资料、药物抗凝方案及肺栓塞发生情况,进行Caprini评分,调查药物抗凝方案对胸腔引流量的影响。结果1500例患者在年龄、性别、体质量指数、病理诊断等方面差异均无统计学意义(P>0.05)。随着时间推移,预防性药物抗凝患者比例逐渐提高,2015~2017年分别为19.4%、65.2%和77.2%。肺栓塞发生率为0.3%(5/1500),2015~2017年肺栓塞病例分别为4、1、0例。肺栓塞发生与抗凝呈负相关(r=-0.04,P=0.07),不抗凝使肺栓塞发生风险增加4.68倍(95%CI:0.525~41.800)。另外,目前使用的药物抗凝方案不增加术后胸腔引流量。结论目前使用的Caprini量表及风险分层适合胸外科术后患者,据此指导的药物性抗凝能够有效预防肺栓塞发生,且不增加术后出血风险。Objective To evaluate the inpatient PE incidence and thromboprophylaxis after thoracic surgery according to adjusted Caprini VTE risk assessment model.Methods The study selected consecutively 500 patients who received thoracic surgery from first of June in consecutive three years of 2015,2016 and 2017.We retrospectively assessed these 1500 patients using Caprini VTE risk model and recorded baseline characteristics,postoperative prophylaxis,and PE incidence.Results Only 19.4%of 2015-year patients received pharmacologic prophylaxis,while the rate reached up to 65.2%in 2016 and 77.2%in 2017.PE occurred on 4 cases in 2015,1 case in 2016,and 0 case in 2017.The overall incidence of PE was 0.3%(5/1500).The PE incidence negatively correlated with the implementation of prophylaxis(r=-0.04,P=0.07).The PE risk(odds ratio)increased 4.68 times(95%CI:0.525-41.800)when patients did not receive prophylaxis in PE cohort.Postoperative pharmacologic prophylaxis with current dosing did not affect the drainage of chest tube after surgery.Conclusion Implementation of an adjusted Caprini risk assessment protocol can be useful for the thoracic postoperative patients to receive appropriate thromboprophylaxis.Current pharmacologic prophylaxis protocol should be safe and enough to prevent PE after thoracic surgery.

关 键 词：肺栓塞 胸外科术后 Caprini血栓风险评估量表 预防性抗凝 

分 类 号：R655[医药卫生—外科学] R563.5[医药卫生—临床医学]