结直肠癌术后并发静脉血栓栓塞症的危险因素及其预防情况  

Risk factors and prevention of postoperative venous thromboembolism in colorectal cancer patients

作　　者：赵莹 曹婉昕 张颖[1] 周效竹 郭明星 崔向丽 Zhao Ying;Cao Wanxin;Zhang Ying;Zhou Xiaozhu;Guo Mingxing;Cui Xiangli(Department of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Key Laboratory of Drug Target Research and Drug Screen,Institute of Materia Medica,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 102600,China)

机构地区：[1]首都医科大学附属北京友谊医院药剂科,北京100050 [2]中国医学科学院北京协和医学院药物研究所,北京市药物靶点研究与新药筛选重点实验室,北京102600

出　　处：《血管与腔内血管外科杂志》2024年第9期1025-1030,共6页Journal of Vascular and Endovascular Surgery

基　　金：北京药学会临床药学研究项目(LCYX-2022-16)。

摘　　要：目的探讨结直肠癌(CRC)患者术后并发静脉血栓栓塞症(VTE)的危险因素及其预防情况。方法收集2022年1—12月于首都医科大学附属北京友谊医院行CRC根治术治疗的93例患者的临床资料,按照是否发生VTE将其分为VTE组(n=17)和非VTE组(n=76),收集CRC患者的相关指标,分析CRC患者术后发生VTE的危险因素及其预防情况。结果单因素分析结果显示,年龄、冠心病、高脂血症、术后D-二聚体水平均是CRC患者术后发生VTE的影响因素(P﹤0.05)。多因素分析结果显示,冠心病、术后D-二聚体≥2.5μg/ml均是CRC患者术后发生VTE的独立危险因素(P﹤0.05)。Caprini评分高危患者中,任何预防措施率为75.56%(68/90),规范预防措施率为27.78%(25/90);Caprini评分中危患者中,任何预防措施率为100%(3/3),规范预防措施率为0。93例CRC患者中,围手术期任何预防措施率为76.34%(71/93),规范预防措施率仅为26.88%(25/93),差异有统计学意义(P﹤0.05)。VTE组患者术前预防及术后规范预防比例均低于非VTE组患者,但差异均无统计学意义(P﹥0.05)。结论多数CRC患者在围手术期均未得到规范的血栓预防管理,临床上动态监测D-二聚体可能有助于判断患者VTE发生风险的变化情况,从而判断预防措施的效果。Objective To investigate the risk factors and prevention of postoperative venous thromboembolism(VTE)in patients with colorectal cancer(CRC).Method Clinical data of 93 patients who underwent radical CRC resection in Beijing Friendship Hospital,Capital Medical University from January to December 2022 were collected,they were divided into VTE group(n=17)and non-VTE group(n=76)according to whether VTE occurred.The related indicators of CRC patients were collected,the risk factors and prevention of postoperative VTE in CRC patients were analyzed.Result Univariate analysis showed that age,coronary heart disease,hyperlipidemia,and postoperative D-dimer level were all influencing factors for postoperative VTE in CRC patients(P<0.05).Multivariate analysis showed that coronary heart disease and postoperative D-dimer≥2.5μg/ml were risk factors for postoperative VTE in CRC patients(P<0.05).Among high-risk patients with Caprini score,the rate of any preventive measures was 75.56%(68/90),and the rate of normative preventive measures was 27.78%(25/90).Among medium-risk patients with Caprini score,the rate of any preventive measures was 100%(3/3),and the rate of normative preventive measures was 0.Among the 93 CRC patients,the rate of any preventive measures in perioperative period was 76.34%(71/93),the rate of standard preventive measures was only 26.88%(25/93),the difference was statistically significant(P<0.05).The proportion of preoperative prophylaxis and postoperative standard prophylaxis in VTE group were lower than those in non-VTE group,but the differences were not statistically significant(P>0.05).Conclusion Most CRC patients have not received standardized thrombosis prevention management in perioperative period.Dynamic clinical monitoring of D-dimer may help to determine the changes in the risk of VTE in patients,so as to judge the effect of preventive measures.

关 键 词：静脉血栓栓塞症 结直肠癌 危险因素 围手术期 血栓预防 

分 类 号：R543[医药卫生—心血管疾病]