系统的个体化防控体系对大血管疾病腔内介入治疗患者围手术期静脉血栓栓塞症的防控效果  

Effect of systematic individual prevention and control system on prevention and control of perioperative venous thromboembolism in patients with macrovascular disease undergoing endovascular interventional therapy

作　　者：党永康[1] 姜学超[1] 杨柳[1] 乌兰 Dang Yongkang;Jiang Xuechao;Yang Liu;Wu Lan(Department of Vascular Surgery,Chifeng Municipal Hospital,Chifeng 024000,Inner Mongolia,China)

机构地区：[1]赤峰市医院血管外科,内蒙古赤峰024000

出　　处：《血管与腔内血管外科杂志》2021年第1期36-41,共6页Journal of Vascular and Endovascular Surgery

基　　金：赤峰市自然科学科研课题(SZR2019036)。

摘　　要：目的评价系统的个体化防控体系对大血管疾病腔内介入治疗患者围手术期静脉血栓栓塞症(VTE)的防控效果。方法选取赤峰市医院于2014年1月至2017年9月尚未开展VTE防控的76例大血管疾病腔内介入手术患者作为对照组,只进行早期下床等一般预防干预;选取2017年10月至2020年12月收治的82例行腔内介入治疗的大血管疾病患者作为防控组,进行系统的个体化VTE防控。比较防控组和对照组患者VTE风险分层、平均风险评分、VTE发生情况。依据抗凝药物使用情况将防控组中可以使用抗凝药物预防的VTE患者分为利伐沙班组和低分子肝素组,利伐沙班组患者口服利伐沙班抗凝,低分子肝素组患者给予皮下注射低分子肝素抗凝,比较两组患者VTE发生情况及出血、血小板减少等并发症发生情况。结果防控组与对照组术前、术后均无VTE极低危和低危患者,两组患者VTE风险分层情况比较,差异无统计学意义(P>0.05)。术后,两组患者的VTE风险评分均高于本组术前,差异均有统计学意义(P<0.05)。防控组患者围手术期VTE发生率为1.22%,低于对照组患者的10.53%,差异有统计学意义(P<0.05)。82例防控组患者中,6例因出血风险较高未进行抗凝药物预防,36例患者口服利伐沙班抗凝预防,40例患者皮下注射低分子肝素抗凝,分别作为利伐沙班组和低分子肝素组,两组患者的VTE发生及并发症发生情况比较,差异均无统计学意义(P>0.05)。结论系统的个体化防控体系能够有效降低大血管疾病腔内介入治疗患者围手术期VTE的发生率;口服利伐沙班预防与皮下注射低分子肝素均可有效预防VTE,但利伐沙班使用更加方便。Objective Evaluation of the system’s individualized prevention and control system for the prevention and control of venous thromboembolism(VTE)in patients undergoing interventional therapy for macrovascular diseases during the perioperative period.Method Selected 76 patients with large vessel disease endovascular interventional surgery who had not undergone VTE prevention and control from January 2014 to September 2017 and were included in the control group,and only received general preventive interventions such as early getting out of bed.Select 82 patients with macrovascular disease who underwent endovascular interventional treatment from October 2017 to December 2020 were included in the prevention and control group for systematic and individualized VTE prevention and control.Compare the VTE risk stratification,average risk score,and VTE occurrence of patients in the prevention and control group and the control group.According to the use of anticoagulants,patients in the prevention and control group who can use anticoagulants for prevention were divided into rivaroxaban group and low molecular weight heparin group.Patients in rivaroxaban group took rivaroxaban orally for anticoagulation,while patients in low molecular weight heparin group were given subcutaneous injection of low molecular weight heparin for anticoagulation.The incidence of VTE,bleeding,thrombocytopenia and other complications were compared between the two groups.Result There were no very low risk and low risk patients of VTE between the control group and the control group before and after operation,and there was no significant difference in the risk stratification of VTE between the two groups(P>0.05).After operation,the VTE risk scores of the two groups were higher than those before operation,and the differences were statistically significant(P<0.05).The incidence of perioperative VTE in the prevention and control group was 1.22%,which was lower than 10.53%in the control group,and the difference was statistically significant(P<0.05).Among t

关 键 词：大血管疾病 介入治疗 静脉血栓栓塞症 防控体系 

分 类 号：R543[医药卫生—心血管疾病]