腹股沟疝围手术期静脉血栓栓塞症预防方案持续改进研究(CHAT-3)  

Study on continuous improvement of prevention program of perioperative venous thromboembolism for inguinal hernia(CHAT-3)

作　　者：刘雨辰[1] 张洪铭 张子超 刘昶[4] 宁宁[5] 张辉[6] 张楠[7] 江礼娟 李航宇[9] 王明刚[1] LIU Yu-chen;ZHANG Hong-ming;ZHANG Zi-chao(Beijing Chaoyang Hospital,Capital Medical University,Beijing100020,China;The Number One Hospital of Zhangjiakou,Zhangjiakou075041,China;不详)

机构地区：[1]首都医科大学附属北京朝阳医院,北京100020 [2]张家口市第一医院,河北张家口075041 [3]清华大学附属第一医院,北京100015 [4]哈尔滨医科大学附属第四医院,黑龙江哈尔滨150001 [5]北京大学国际医院,北京102206 [6]河南省人民医院,河南郑州450003 [7]天津市南开医院,天津300102 [8]重庆市长寿区人民医院,重庆401220 [9]中国医科大学附属第四医院,辽宁沈阳110032

出　　处：《中国实用外科杂志》2022年第3期293-297,共5页Chinese Journal of Practical Surgery

基　　金：国家卫生健康委医院管理研究所医疗质量循证管理持续改进研究项目(No.YLZLXZ-2020-006)。

摘　　要：目的验证腹股沟疝手术病人静脉血栓栓塞症(VTE)专科版评估预防方案的安全性和有效性。方法收集2020-06-01—2021-06-30来自国内9家医院的腹股沟疝手术1234例病人资料,随机分为试验组和对照组,试验组采用专科版评估预防方案,对照组采用现行评估预防方案。记录病人的一般资料、疝类型、手术时间、手术方式、术前实验室检查、下肢血管超声等。术后随访4周,分别记录两组病人的实验室检查结果。对两组病人的评估率和预防率进行比较。结果两组病人的一般资料差异无统计学意义(P>0.05),两组病人术前实验室检查差异无统计学意义(P>0.05)。试验组术前通过筛查方案筛查D-二聚体(D-Dimer)异常者27例(5.23%),经超声证实VTE阳性病例8例(1.55%),评估后使用低分子肝素预防132例(25.58%),使用口服抗凝药4例(0.77%);对照组术前通过筛查方案筛查D-Dimer异常者36例(5.95%),经超声证实VTE阳性病例13例(2.15%),根据现有评估方案评估后使用低分子肝素预防23例(3.80%),口服抗凝药14例(2.31%)。术后1周随访,两组病人的DDimer和PLT数值差异具有统计学意义(P<0.05),试验组显著低于对照组。术后4周随访,两组病人的D-Dimer、白细胞(WBC)、血小板(PLT)、丙氨酸转氨酶(ALT)、天冬氨酸转移酶(AST)数值两组差异无明显统计学意义(P>0.05)。结论腹股沟疝手术VTE专科版评估预防方案是安全有效的,相比于Caprini评估体系更为精准,能够保证病人围手术期VTE管理需求。ObjectiveTo verify the safety and effectiveness of VTE specialist assessment for prevention in patientsundergoing inguinal hernia surgery.MethodsData of patients undergoing inguinal hernia surgery from 9 differenthospitals from June 2020 to June 2021 were collected,and they were randomly divided into observation group andcontrol group.The observation group was evaluated with the specialized version of the prevention plan,and the control group was assessed with the current prevention planof each center.General information,hernia type,operation time,operation method,preoperativelaboratory examination and lower extremity vascularultrasound were recorded.The changes of laboratoryexaminations in the two groups were recorded duringthe 4-week follow-up.The assessment rate andprevention rate were compared between the twogroups.ResultsThere was no significant differencein general data between the two groups(P>0.05),and no significant difference in preoperativelaboratory examinations between the two groups(P>0.05).In the experimental group,27 cases(5.23%)with D-DImer abnormality were screened by screening programbefore surgery,8 cases(1.55%)were VTE positive confirmed by ultrasound,132 cases(25.58%)were prophylactic withlow molecular weight heparin and 4 cases(0.77%)were oral anticoagulant after evaluation of preliminary screeningprogram.In the control group,36 cases(5.95%)with D-Dimer abnormality were screened by preoperative screeningprogram,13 cases(2.15%)with VTE positive confirmed by ultrasound,23 cases(3.80%)with low molecular weightheparin for prophylaxis and 14 cases(2.31%)with oral anticoagulant were evaluated according to the existing evaluationprogram of each center.One week after surgery,the difference in D-Dimer and PLT values between the two groups wasstatistically significant(P<0.05),and the experimental group was significantly lower than the control group.Four weeksafter surgery,there were no significant differences in d-Dimer,WBC,PLT,ALT and AST between the two groups(P>0.05).ConclusionThe specialized eval

关 键 词：腹股沟疝 静脉血栓栓塞症 评估 预防 管理 

分 类 号：R6[医药卫生—外科学]