Caprini模型在神经重症颅脑术后患者下肢深静脉血栓形成筛查中的应用价值  

Application value of Caprini model in the screening of deep venous thrombosis in neurosurgery patients admitted to intensive care unit

作　　者：张冉[1] 蔡卫新[2] 石广志[1] 王君[1] 冯雅笛 袁媛[1] 赵经纬[1] 杨燕琳[1] 孙雪 陶帅 Zhang Ran;Cai Weixin;Shi Guangzhi;Wang Jun;Feng Yadi;Yuan Yuan;Zhao Jingwei;Yang Yanlin;Sun Xue;Tao Shuai(Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Nursing,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070 [2]首都医科大学附属北京天坛医院护理部,北京100070

出　　处：《首都医科大学学报》2023年第1期20-26,共7页Journal of Capital Medical University

基　　金：北京市优秀人才培养资助青年骨干个人项目(2018000021469G236);北京市临床重点专科项目(2100199)。

摘　　要：目的探讨Caprini模型在神经重症颅脑手术患者术后7 d内下肢深静脉血栓形成筛查中的应用价值。方法以2020年1月至2022年6月首都医科大学附属北京天坛医院重症医学科收治的神经外科颅脑术后患者为研究对象,选取其中发生深静脉血栓(deep vein thrombosis,DVT)的150例患者为病例组,按照1∶2成组匹配方法选取同期住院未发生DVT的300例患者为对照组。采用大数据智能分析平台收集两组研究对象的一般资料和临床资料,依据Caprini模型对两组研究对象进行评分及DVT风险分级。比较两组患者的Caprini模型得分及不同风险分级患者的DVT发生风险,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析Caprini模型筛查DVT的价值。结果Caprini模型评估结果显示,病例组Caprini模型平均评分为(5.88±1.98)分,高于对照组的(4.11±1.74)分,组间差异有统计学意义(P<0.05)。450例患者Caprini模型DVT风险分级均为中危及以上,其中中危组93例(20.7%)、高危组121例(26.9%)、极高危组236例(52.4%),病例组高风险的暴露比例明显高于对照组,其中极高危患者发生DVT的风险是中危患者的5.75倍(P<0.05)。二元Logistic回归显示,年龄、Caprini模型得分、D-二聚体是神经重症颅脑术后患者发生DVT的独立影响因素(P<0.05)。Caprini模型筛查神经重症颅脑手术患者DVT的ROC曲线下面积为0.746(95%CI:0.696~0.796);以模型得分>5.5为筛查界值,其筛查DVT的灵敏度为61.3%,特异度为79.3%,筛查结果与彩色B超诊断结果的一致性为中等(Kappa=0.404),具有一定临床应用价值。结论Caprini模型可用于神经重症颅脑术后患者术后7 d内DVT的初步筛查,但是该模型灵敏度较低且DVT风险分级需优化,未来应进一步开展研究,为筛查或预测神经重症颅脑术后患者DVT的发生提供有效评估工具。Objective To analyze the application value of Caprini model in the screening of deep venous thrombosis(DVT)within 7 d after neurosurgery.Methods Neurosurgery patients admitted to Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University from January 2020 to June 2022 were selected.A total of 150 patients with DVT were included in the case group,while 300 hospitalized patients without DVT were included in the control group at a ratio of 1∶2.The general and clinical data were collected with the big data intelligent analysis platform.The DVT scores and risk classification were conducted based on the Caprini model.The Caprini model scores and the risk of DVT in patients with different DVT risk grades were compared to each other.The value of Caprini model in screening DVT was assessed with receiver operating characteristic(ROC)curve.Results According to the Caprini model,the mean Caprini score of the case group was 5.88±1.98,which was significantly higher than that in the control group 4.11±1.74(P<0.05).The DVT risk level of 450 patients was above moderate risk,including 93 patients in the moderate risk group(20.7%),121 patients in the high risk group(26.9%),and 236 patients in the very high risk group(52.4%).The proportion of high risk exposure in the case group was significantly higher than that in the control group,and the risk of DVT in the very high risk group was 5.75 times that in the moderate risk group(P<0.05).Logistic regression showed that age,Caprini model score and,D-dimer were independent influencing factors(P<0.05).The area under the ROC curve of Caprini model was 0.746(95%CI:0.696-0.796).When the score was 5.5,the sensitivity and specificity of DVT screening were 61.3%and 79.3%,respectively.The consistency between screening results and ultrasound diagnosis results was moderate(Kappa=0.404).Conclusion Caprini model can be used for preliminary screening of DVT within 7 d after craniocerebral surgery,but the sensitivity is low and the risk stratification of DVT needs to

关 键 词：Caprini模型 颅脑手术 神经重症 深静脉血栓 筛查价值 护理 

分 类 号：R543[医药卫生—心血管疾病]