妇科手术围手术期发生静脉血栓栓塞症的影响因素分析  

Influencing factors of venous thromboembolism in the perisurgical period of gynecological surgery

作　　者：方欢 黄劲峰 高伟祺[3] 牛战琴[1] FANG Huan;HUANG Jinfeng;GAO Weiqi;NIU Zhangqin(Department of Gynecology and Obstetrics,the Third Hospital of Shanri Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan,Shanxi 030032,China;Department of Urology Surgery,the Third Hospital of Shanzi Medical University,Taiyuan,Shanxi 030032,China;Department of Pharmacy,the Third Hospital of Shanxi Medical University,Taiyuan,Shanxi 030032,China)

机构地区：[1]山西医科大学第三医院妇产科,山西白求恩医院,山西医学科学院同济山西医院,山西太原030032 [2]山西医科大学第三医院泌尿外科,山西太原030032 [3]山西医科大学第三医院药学部,山西太原030032

出　　处：《中华实用诊断与治疗杂志》2024年第9期941-946,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：吴阶平医学基金会临床科研专项(320.6750.2021-08-12)。

摘　　要：目的分析妇科手术围手术期静脉血栓栓塞症(VTE)发生的危险因素,探讨术后个体化治疗预防肺栓塞的价值。方法回顾性分析2022年2月—2023年10月山西医科大学第三医院妇科手术围手术期57例发生VTE患者(VTE组)和114例未发生VTE患者(对照组)的临床资料。记录VTE组预防下肢深静脉血栓(DVT)方法及肺栓塞发生情况;比较2组年龄、体质量指数、疾病类型、基础疾病、手术入路、术式、手术时间、术后血容量、妊娠或产褥期比率;采用多因素logistic回归分析妇科手术围手术期发生VTE的影响因素。结果(1)VTE组17例术后Caprini评分≥5分,即刻行双下肢深静脉彩超提示术中DVT形成,给予双下肢制动、个体化抗凝治疗,住院期间均未发生肺栓塞。另40例术后先给予物理治疗,术后6~12 h后给予个体化抗凝治疗预防DVT形成;9例物理治疗期间出现D-二聚体升高及肺栓塞症状,行双下肢深静脉彩超及CT肺动脉造影诊断为肺栓塞;20例术后物理治疗期间、11例抗凝治疗期间D-二聚体升高,行双下肢深静脉彩超提示DVT形成。(2)VTE组年龄≥60岁(29.82%)、恶性或卵巢交界性肿瘤(57.89%)、合并高血压(38.60%)、合并糖尿病(31.58%)、子宫切除术(42.11%)、子宫切除+淋巴结清扫术(47.37%)、开腹手术(38.60%)、手术时间≥180 min(56.14%)、术后血容量不足(21.05%)比率均高于对照组(13.16%、21.93%、17.54%、17.54%、34.21%、21.93%、21.93%、22.81%、9.65%)(χ^(2)=0.011、20.354、9.090、4.331、21.622、21.622、5.296、18.838、4.245,P均<0.05),体质量指数、妊娠或产褥期比率与对照组比较差异均无统计学意义(P>0.05)。(3)恶性或卵巢交界性肿瘤(OR=9.313,95%CI:3.673~23.630,P<0.001)、开腹手术(OR=15.269,95%CI:4.035~57.771,P<0.001)、子宫切除+淋巴结清扫术(OR=2.831,95%CI:1.053~7.601,P=0.039)、手术时间≥180 min(OR=26.576,95%CI:6.949~101.691,P<0.001)是妇科手术围手术期发生VTE的危险因素。结�Objective To analyze the risk factors of venous thromboembolism(VTE)in the perisurgical period of gynecological surgery and to explore the value of postsurgical individualized therapy to the prevention of pulmonary embolism(PE).Methods A retrospective analysis was conducted on the clinical data of 57 cases of VET(VTE group)and 114 cases without VTE(control group)in the perisurgical period of gynecological surgery in the Third Hospital of Shanxi Medical University from February 2022 to October 2023.The deep venous thrombosis(DVT)preventive method and occurrence of PE were recorded in VTE group.The age,body mass index,type of disease,underlying diseases,surgical approach,surgical technique,duration of surgery,blood volume after surgery,and proportion of pregnancy or puerperium were compared between two groups.Multivariate logistic regression analysis was conducted to identify the influencing factors of VTE in the perisurgical period of gynecological surgery.Results(1)In VTE group,17 patients with a postsurgical Caprini score of≥5 were subjected to immediate bilateral lower limb ultrasonography,revealing the formation of intrasurgical DVT,and they were found no PE during their hospitalization after immobilization of both lower limbs and individualized anticoagulation therapy.The other 40 patients were subjected to physical therapy after surgery and subsequent individualized anticoagulation therapy 6 to 12 h after surgery to prevent DVT formation.Nine patients with elevated D-dimer level and symptoms of PE during physical therapy were confirmed as PE by bilateral lower limb ultrasonography and CT pulmonary angiography.Twenty patients during physical therapy and 11 during anticoagulation therapy experienced elevated D-dimer level and were diagnosed with DVT by bilateral lower limb ultrasonography.(2)In VTE group,the proportions of age≥60 years(29.82%),malignant/borderline ovarian tumors(57.89%),hypertension(38.60%),diabetes(31.58%),hysterectomy(42.11%),hysterectomy+lymph node dissection(47.37%),open abdominal surg

关 键 词：静脉血栓栓塞症 妇科手术 危险因素 肺栓塞 

分 类 号：R713[医药卫生—妇产科学]